Contrast-enhanced MRI provides the greatest soft-tissue detail for evaluation of uterine fibroids and is particularly helpful in evaluating for symptomatic complications including hemorrhage, torsion, infarction, and prolapse [22,31- 33]. MRI is probably not necessary as a primary imaging modality in uncomplicated cases of PID, but it is useful for anatomic specificity and facilitating treatment planning [12,24,34,35]. MRI is reported to be 95% sensitive and 89% specific for evaluation of hydrosalpinx [36]. The majority of the above reports have focused on the utility of contrast-enhanced MRI, but valuable information can often be derived from noncontrast protocols with emphasis on T2-weighted imaging. Abbreviated MRI Postmenopausal Acute Pelvic Pain protocols without IV contrast have demonstrated 73% accuracy for diagnosis of acute pelvic pain in a mixed group of men, pregnant women, and nonpregnant women [29]. US Pelvis Transabdominal US is considered a first-line imaging modality for evaluation of pelvic pain of suspected gynecologic origin [37]. Transabdominal US is most often performed in conjunction with transvaginal US. Transabdominal US has the benefit of a larger field of view that allows visualization of the uterus and adnexa, but also the remainder of the pelvic contents, including free pelvic fluid. Transabdominal US is well tolerated by patients; however, it can be limited by patient body habitus. The evidence presented below for transvaginal US generally assumes a combined approach using both techniques. US Pelvis Transvaginal Transvaginal US is considered a first-line imaging modality for evaluation of pelvic pain of suspected gynecologic origin and, although it may be performed independently, is usually performed at the same time as a transabdominal US per the ACR-ACOG-AIUM-SPR-SRU Practice Parameter for the Performance of Ultrasound of the Female Pelvis [37].
Postmenopausal Acute Pelvic Pain. Contrast-enhanced MRI provides the greatest soft-tissue detail for evaluation of uterine fibroids and is particularly helpful in evaluating for symptomatic complications including hemorrhage, torsion, infarction, and prolapse [22,31- 33]. MRI is probably not necessary as a primary imaging modality in uncomplicated cases of PID, but it is useful for anatomic specificity and facilitating treatment planning [12,24,34,35]. MRI is reported to be 95% sensitive and 89% specific for evaluation of hydrosalpinx [36]. The majority of the above reports have focused on the utility of contrast-enhanced MRI, but valuable information can often be derived from noncontrast protocols with emphasis on T2-weighted imaging. Abbreviated MRI Postmenopausal Acute Pelvic Pain protocols without IV contrast have demonstrated 73% accuracy for diagnosis of acute pelvic pain in a mixed group of men, pregnant women, and nonpregnant women [29]. US Pelvis Transabdominal US is considered a first-line imaging modality for evaluation of pelvic pain of suspected gynecologic origin [37]. Transabdominal US is most often performed in conjunction with transvaginal US. Transabdominal US has the benefit of a larger field of view that allows visualization of the uterus and adnexa, but also the remainder of the pelvic contents, including free pelvic fluid. Transabdominal US is well tolerated by patients; however, it can be limited by patient body habitus. The evidence presented below for transvaginal US generally assumes a combined approach using both techniques. US Pelvis Transvaginal Transvaginal US is considered a first-line imaging modality for evaluation of pelvic pain of suspected gynecologic origin and, although it may be performed independently, is usually performed at the same time as a transabdominal US per the ACR-ACOG-AIUM-SPR-SRU Practice Parameter for the Performance of Ultrasound of the Female Pelvis [37].