ACR appropriateness criteria(®) on abnormal vaginal bleeding

Area of Science:

• Radiology
• Gynecologic Imaging
• Diagnostic Imaging

Background:

• Abnormal vaginal bleeding requires careful evaluation, where imaging complements histologic diagnosis.
• Endometrial thickness is a crucial metric, particularly in postmenopausal women, for predicting endometrial disease.

Purpose of the Study:

• To review the role of various imaging modalities in evaluating abnormal vaginal bleeding.
• To discuss the utility and limitations of endometrial thickness measurements in different patient populations.
• To outline the appropriate use of ultrasound, hysterosonography, MRI, and CT in gynecologic imaging.

Main Methods:

• Review of current literature on imaging techniques for abnormal uterine bleeding.
• Discussion of transvaginal ultrasound (TVUS) as the primary modality.
• Exploration of adjunctive techniques including transabdominal ultrasound, hysterosonography, Doppler, MRI, and CT.

Main Results:

• TVUS is the initial choice; endometrial thickness thresholds (≤5 mm, ≤4 mm) are debated for asymptomatic postmenopausal women.
• Endometrial thickness is less reliable in premenopausal women due to menstrual cycle variations.
• Hysterosonography, Doppler, and MRI offer enhanced visualization and characterization of endometrial abnormalities.
• CT is generally not recommended for abnormal bleeding evaluation.

Conclusions:

• Imaging is essential for screening and characterizing structural abnormalities in abnormal vaginal bleeding.
• Appropriate selection of imaging modality, guided by clinical context, optimizes patient care.
• Further research is needed to establish definitive endometrial thickness thresholds in specific patient groups.