ACR (American College of Radiology) Appropriateness Criteria Pelvic Floor Dysfunction in Females. 2022.

APPROPRIATE USE CRITERIA.  

Variant 1: Vaginal protrusion or bulge, or clinically suspected pelvic organ prolapse. ACR Statement.

-US Pelvis Transabdominal (CPT 76856): To our knowledge, there is no relevant literature regarding the use of transabdominal US (TAUS) for assessment of a protruding or bulging vaginal mass or clinically suspected POP.

 -US Pelvis Transvaginal (CPT 76830). To our knowledge, there is no relevant literature regarding the use of transvaginal US (TVUS) alone for functional assessment of a protruding or bulging anterior vaginal mass or clinically suspected POP.

Variant 2: Female. Urinary dysfunction (involuntary leakage of urine, or frequent urination, or urgency, or straining to void, or incomplete voiding, or splinting, or digital maneuvers to void). ACR Statement.

-US Pelvis Transabdominal (CPT 76856). To our knowledge there is no relevant literature regarding the use of TAUS for functional evaluation of the urethra or bladder neck in patients with urinary dysfunction.

-US Pelvis Transvaginal (CPT 76830). To our knowledge, there is no relevant literature regarding the use of TVUS for functional evaluation of patients with urinary dysfunction.

Variant 3: Female. Defecatory dysfunction (incontinence of stool or liquid or gas, or straining during defecation, or difficulty initiating defecation, or incomplete evacuation, or splinting or digital maneuvers to defecate). ACR Statement.

-US Pelvis Transabdominal (CPT 76856). To our knowledge, there is no relevant literature to support the use of TAUS for assessment of defecatory dysfunction.

-US Pelvis Transvaginal. TVUS (CPT 76830). To our knowledge, there is no relevant literature comparing the utility of TVUS for assessment of defecatory dysfunction.

Variant 4: Female. Follow-up imaging after pelvic floor surgery. Subacute or chronic complications other than recurrent pelvic floor dysfunction. ACR Statement.

-US Pelvis Transabdominal (CPT 76856). Postoperative complications such as urinary retention and acute retropubic hematomas can be assessed with US; however, to our knowledge, there is no relevant literature regarding the use of TAUS for subacute or chronic complications of pelvic floor surgical repair.

ACR Statement:

Pelvic floor US, which is most commonly transperineal with dynamic pelvic floor maneuvers, plays an emerging role in providing a global picture of the pelvic floor compartments and a real-time dynamic evaluation of pelvic floor dysfunction, in addition to providing details in patients who have undergone midurethral sling or vaginal mesh implants and present with complications related to their procedure.

Novasono Statement: In contrast to resource-intensive MRI-based examinations, transperineal pelvic floor ultrasound offers a low-cost, noninvasive, radiation-free, scalable, real-time screening approach supported by strong evidence (SOE) in the ACR Appropriateness Criteria.