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MRI Pelvis 72195 72196 72197

1.1 Bleeding, pelvic

1.1.1 Ultrasound nondiagnostic

1.2 Cramping, severe

1.2.1 Endometriosis suspected

1.3 Cyclical Pelvic Pain

1.3.1 Endometriosis suspected

1.4 Dysmenorrhea

1.4.1 Adenomyosis suspected

1.5 Dysparunia

1.5.1 Adenomyosis suspected

1.5.2 Endometriosis suspected

1.6 Fever

1.6.1 Abdominal Pain

1.6.2 Leukocytosis

1.6.3 Pelvic pain

1.6.4 US nondiagnostic

1.7.1.1 Dysmenorrhea

1.7.1.2 Enlarged uterus by PE or US

1.7.1.3 Infertility

1.7.1.4 Pelvic pain

1.7.1.5 Uterine bleeding

Doherty and Way, eds; Current Surgical Dianosis and Treatment, 12th Ed.; Chapter 41 Gynecology Edw Hill and Elena Gates

1.7.2.1 Dysmennorrhea with onset in the 20s or 30s

1.7.2.2 Dyspareunia

1.7.2.3 Pain, usually pelvic but can be in other locations

1.7.2.4 Painful defecation

1.8.1.1 Dysmenorrhea

1.8.1.2 Enlarged uterus by PE or US

1.8.1.3 Infertility

1.8.1.4 Pelvic pain

1.8.1.5 Uterine bleeding

1.8.2.1 Dysmennorrhea with onset in the 20s or 30s

1.8.2.2 Dyspareunia

1.8.2.3 Pain, usually pelvic but can be in other locations

1.8.2.4 Painful defecation

1.9.1 Fistula suspected

1.9.2.1 Dysmennorrhea with onset in the 20s or 30s

1.9.2.2 Dyspareunia

1.9.2.3 Pain, usually pelvic but can be in other locations

1.9.2.4 Painful defecation

1.10.1 Ultrasound nondiagnostic

2.1.1 Abdominal or pelvic pain

2.1.2 Chills

2.1.3 Fever

2.1.4 Leukocytosis

2.1.5 Mass by physical examination or US

2.1.6 Purulent Discharge (cervical or vaginal)

2.1.7 Tenderness, pelvic, adnexal or cervical

2.2.1 Dysmenorrhea

2.2.2 Enlarged uterus by PE or US

2.2.3 Infertility

2.2.4 Pelvic pain

2.2.5 Uterine bleeding

2.2.6.1 Doherty and Way, eds; Current Surgical Dianosis and Treatment, 12th Ed.; Chapter 41 Gynecology Edw Hill and Elena Gates

2.3.1 Acute onset of pain

2.3.2 Falling blood pressure

2.3.3 Shock

2.4 Arcuate Uterus

2.4.1 Ultrasound nondiagnostic

2.5 Bicornuate uterus

2.5.1 Ultrasound nondiagnostic

2.6 Didelphic uterus

2.6.1 Ultrasound nondiagnostic

2.7 Endometriosis Endometriosis is the presence of endometrial tissue in extauterine sites. Most frequently in the pelvis

2.7.1 Dysmennorrhea with onset in the 20s or 30s

2.7.2 Dyspareunia

2.7.3 Pain, usually pelvic but can be in other locations

2.7.4 Painful defecation

2.8.1 Groin bulging

2.8.2 Local groin pain

2.8.3.1 Schwartz’s Principles of Surgery, 8th Edition F. Charles Brunicardi, Chapter 36. Inguinal Hernias Robert J. Fitzgibbons, Jr., Charles J. Filipi, Thomas H. Quinn

2.8.3.2 Elsayes, Khaled M., Staveteig, Paul T., Narra, Vamsidhar R., Leyendecker, John R., Lewis, James S., Jr., Brown, Jeffrey J. MRI of the Peritoneum: Spectrum of Abnormalities Am. J. Roentgenol. 2006 186: 1368-1379

2.8.3.3 RSNA Education Exhibits: Priya R. Bhosale, Madhavi Patnana, Chitra Viswanathan, and Janio Szklaruk The Inguinal Canal: Anatomy and Imaging Features of Common and Uncommon Masses Radiographics May-June 2008 28:819-835;

2.9.1.1 History of Breast or Lung cancer

2.9.1.2 History of radiation therapy to the lumbosacral spine

2.9.2 Incontinence

2.9.3 Numbness

2.9.4 Paresthesias

2.9.5 Radiating pain

2.9.6 Weakness of lower extremity

2.11.1.1 New pelvic symptoms or findings

2.12.1 Ultrasound nondiagnostic

2.15.1 Ultrasound nondiagnostic

2.16 Suspected fracture, routine imaging nondiagnostic

2.17.1 Elevated PSA (prostate-specific antigen) level (> 4.0 ng/mL) and negative prostate biopsy

2.17.2 Planning of ultrasound biopsy using MRI/US fusion

2.17.3 Mass on digital rectal exam

2.17.4 Positive prostate biopsy with need for extent of disease evaluation and no prior MRI pelvis exam

1. Eberhardt SC, Carter S, Casalino DD, et al. Expert panels on urologic imaging and radiation oncology-prostate, American College of
Radiology Appropriateness criteria- Prostate cancer-pretreatment detection staging and surveillance, accessed at

http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ProstateCancerPretreatmentDetectionStagingSurveillance.pdf

2. Casalino DD, Remer EM, Arellano RS,, et al. Expert Panel on Urologic Imaging and Radiation Oncology????Prostate. American College of Radiology ACR Appropriateness Criteria ???? Post treatment follow up of prostate cancer accessed at . http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/PostTreatmentFollowUpProstateCancer.pdf

2. Casalino DD, Remer EM, Arellano RS,, et al. Expert Panel on Urologic Imaging and Radiation Oncology????Prostate. American College of Radiology ACR Appropriateness Criteria ???? Post treatment follow up of prostate cancer accessed at . http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/PostTreatmentFollowUpProstateCancer.pdf

3. Mohler JL, Kantoff PW, Armstrong AJ, et al. National Comprehensive Cancer Network (NCCN) Guideline Version 1.2014. Prostate Cancer.

3.2 Mass by Physical Exam or prior imaging

3.2.1 US nondiagnostic

3.4.1 Ultrasound not diagnostic

4.1 Leukocytosis

4.1.1 Abdominal or Pelvic pain

4.1.2 Fever

4.1.3 US nondiagnostic

4.2.1 Pelvic Ultrasound exam is indeterminate or suspicious

4.3 Uterine anomaly (US nondiagnostic)

4.4 Uterine enlargement

4.4.1 Ultrasound not diagnostic

4.5.1 Ultrasound not diagnostic

5.1 Abscess, known

5.1.1 Follow up during or after treatment

5.2 Aneurysm, known, follow up

5.2.1 Interval evaluation after repair of aneurysm

5.2.2 Routine follow up every 6 – 12 months

5.3 Bladder cancer

5.3.1 Staging or restaging

5.4 Cervical cancer

5.4.1 Staging or restaging

5.5 Colon Cancer

5.5.1 Staging or restaging

5.6.1 Ultrasound nondiagnostic

5.6.2.1.1 Spielmann, Audrey L., Keogh, Ciaran, Forster, Bruce B., Martin, Michael L., Machan, Lindsay S. Comparison of MRI and Sonography in the Preliminary Evaluation for Fibroid Embolization Am. J. Roentgenol. 2006 187: 1499-1504

5.6.2.1.2 LeBlang, Suzanne D., Hoctor, Katherine, Steinberg, Fred L. Leiomyoma Shrinkage After MRI-Guided Focused Ultrasound Treatment: Report of 80 Patients Am. J. Roentgenol. 2010 194: 274-280

5.7.1 Interval follow up during and after treatment

5.7.2 Preoperative

5.7.3 Worsening clinical situation

5.7.4.1 Parsonnet Jeffrey, “Chapter 120. Osteomyelitis” (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison’s Principles of Internal Medicine, 17th Edition: http://www.accessmedicine.com/content.aspx?aID=2893649.

5.7.4.2 Alok Kapoor, Stephanie Page, Michael LaValley, Daniel R. Gale, and David T. Felson Magnetic Resonance Imaging for Diagnosing Foot Osteomyelitis: A Meta-analysis Arch Intern Med, Jan 2007; 167: 125 – 132.

5.7.4.3 J. Herman Kan, Melissa A. Hilmes, Jeffrey E. Martus, Chang Yu, and Marta Hernanz-Schulman Value of MRI After Recent Diagnostic or Surgical Intervention in Children with Suspected Osteomyelitis Am. J. Roentgenol., Nov 2008; 191: 1595 – 1600.

5.7.4.4 Kuo-Chen Lee, Yi-Ting Tsai, Chih-Yuan Lin, and Chien-Sung Tsai Vertebral osteomyelitis combined streptococcal viridans endocarditis Eur. J. Cardiothorac. Surg., Jan 2003; 23: 125.

5.7.4.5 D Allen, S Ng, K Beaton, and D Taussig Sternal osteomyelitis caused by Aspergillus fumigatus in a patient with previously treated Hodgkin’s disease J. Clin. Pathol., Aug 2002; 55: 616 – 618.

5.7.4.6 M Ida, H Watanabe, A Tetsumura, and T Kurabayashi CT findings as a significant predictive factor for the curability of mandibular osteomyelitis: multivariate analysis Dentomaxillofac. Radiol., Mar 2005; 34: 86 – 90.

5.7.4.7 Jyri K. Koort, Tatu J. Mäkinen, Juhani Knuuti, Jari Jalava, and Hannu T. Aro Comparative 18F-FDG PET of Experimental Staphylococcus aureus Osteomyelitis and Normal Bone Healing J. Nucl. Med., Aug 2004; 45: 1406 – 1411.

5.7.4.8 Susan A. Connolly, Leonard P. Connolly, Laura A. Drubach, David Zurakowski, and Diego Jaramillo MRI for Detection of Abscess in Acute Osteomyelitis of the Pelvis in Children Am. J. Roentgenol., Oct 2007; 189: 867 – 872.

5.9.1 Before Myomectomy or Hysterectomy

5.9.2 Before Uterine Artery Embolization

5.10.1 Positive prostate biopsy for diagnosis of prostate cancer with need for staging or treatment planning and no prior MRI pelvis exam

5.10.2.1 Immediately following prostatectomy (removal of prostate gland) with detectable PSA (prostate-specific antigen) level

5.10.2.2 Prior prostatectomy (removal of prostate gland) with rising PSA (prostate-specific antigen)

5.10.2.3 Following radiation therapy with rising PSA (prostate-specific antigen) level or palpable mass on digital rectal exam

5.10.2.4 Following treatment with hormone therapy (androgen deprivation therapy) and rising PSA (prostate-specific antigen) level

1. Eberhardt SC, Carter S, Casalino DD, et al. Expert panels on urologic imaging and radiation oncology-prostate, American College of
Radiology Appropriateness criteria- Prostate cancer-pretreatment detection staging and surveillance, accessed at

http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ProstateCancerPretreatmentDetectionStagingSurveillance.pdf

2. Casalino DD, Remer EM, Arellano RS,, et al. Expert Panel on Urologic Imaging and Radiation Oncology????Prostate. American College of Radiology ACR Appropriateness Criteria ???? Post treatment follow up of prostate cancer accessed at . http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/PostTreatmentFollowUpProstateCancer.pdf

2. Casalino DD, Remer EM, Arellano RS,, et al. Expert Panel on Urologic Imaging and Radiation Oncology????Prostate. American College of Radiology ACR Appropriateness Criteria ???? Post treatment follow up of prostate cancer accessed at . http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/PostTreatmentFollowUpProstateCancer.pdf

3. Mohler JL, Kantoff PW, Armstrong AJ, et al. National Comprehensive Cancer Network (NCCN) Guideline Version 1.2014. Prostate Cancer.

5.11.1 Staging or restaging

5.12.1 Initial staging

5.12.2 Surveillance imaging (SEE ONCOLOGY ROUTINE IMAGING)

5.13.1.1 FritzschePJ, Hricak H, Kogan BA, Winkler ML, Tanagho EA. Undescended testes: the role of MR imaging. Radiology 1987;164:169-173

5.13.1.2 Elder, Jack S. Ultrasonography Is Unnecessary in Evaluating Boys With a Nonpalpable Testis Pediatrics 2002 110: 748-751 The author indicates that imaging was noncontributory in identifying the non-palpable testis, and in determining surgical approach

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