However, data from mixed cohorts of patients with recurrence of cervical, vaginal, and other gynecologic cancers have suggested superior sensitivity of FDG-PET/CT for pelvic nodal metastases compared with pelvic MRI and CT [29,30]. If MRI of the abdomen and pelvis is used in place of CT of the abdomen and pelvis, the addition of chest CT is encouraged to evaluate for pulmonary metastases. The use of IV contrast may improve tissue characterization and is particularly beneficial when MRI of the abdomen is included, because it improves detection of hepatic metastases. Radiography Intravenous Urography There is no relevant literature regarding the use of radiographic IV urography in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. US Pelvis Transvaginal There is no relevant literature regarding the role of TVUS in the evaluation of known or suspected vaginal cancer recurrence nor is there any such literature for cervical cancer recurrence. Additionally, the potential applicability of TVUS for recurrent vaginal cancer would be limited to local recurrence, because TVUS has little to no utility for pelvic nodal evaluation [39]. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac. Appropriateness Category Names and Definitions Relative Radiation Level Information Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure.
Staging and Follow up of Primary Vaginal Cancer. However, data from mixed cohorts of patients with recurrence of cervical, vaginal, and other gynecologic cancers have suggested superior sensitivity of FDG-PET/CT for pelvic nodal metastases compared with pelvic MRI and CT [29,30]. If MRI of the abdomen and pelvis is used in place of CT of the abdomen and pelvis, the addition of chest CT is encouraged to evaluate for pulmonary metastases. The use of IV contrast may improve tissue characterization and is particularly beneficial when MRI of the abdomen is included, because it improves detection of hepatic metastases. Radiography Intravenous Urography There is no relevant literature regarding the use of radiographic IV urography in the modern imaging workup of vaginal cancer, and its use has largely been replaced by cross-sectional imaging techniques. US Pelvis Transvaginal There is no relevant literature regarding the role of TVUS in the evaluation of known or suspected vaginal cancer recurrence nor is there any such literature for cervical cancer recurrence. Additionally, the potential applicability of TVUS for recurrent vaginal cancer would be limited to local recurrence, because TVUS has little to no utility for pelvic nodal evaluation [39]. Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac. Appropriateness Category Names and Definitions Relative Radiation Level Information Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure.