Ultrasound Best for Investigating Pelvic Symptoms

Ultrasound should be the primary imaging tool when examining women who present with pelvic symptoms, a group of 7 physicians urge in the American Journal of Obstetrics & Gynecology.

Not only is ultrasound safe, it is significantly more cost-effective than other imaging modalities, the authors argued in support of a broader campaign of the American Institute of Ultrasound Medicine (AIUM), which urges to “put ultrasound first.”

Key Point:

- Clinicians should utilize ultrasounds before any other imaging technologies when investigating the source of pelvic pain in women.

The recommendation, which is spelled out in an opinion piece that published online March 31, suggests that for women presenting with things such as pelvic pain, masses, flank pain, should first have an ultrasound. Too often clinicians send women for CT scans, which are more costly and involve unnecessary radiation.

"This recommendation applies particularly to obstetric and gynecologic patients,” explained lead author and AIUM president Beryl R. Benacerraf, MD, Clinical Professor in Obstetrics, Gynecology, and Reproductive Biology and Radiology at Harvard Medical School, and Brigham and Women's Hospital, in a news release. “A skillfully performed and well-interpreted ultrasound usually eliminates the need to perform additional more costly and complex cross-sectional imaging techniques.”

CT and MRI of the pelvis can provide indeterminate and confusing findings that only then lead to a need for an ultrasound to better clarify the results, she explained.

In supporting their argument, the authors also point to the major advances in ultrasound technology, including 3D volume imaging, real-time evaluation of pelvic organs along with a physical examination with the transvaginal ultrasound transducer, and Doppler blood flow mapping.

"Doing a CT scan first for female patients with lower abdominal pain is dangerous, wasteful, and expensive," noted Benacerraf. "We must educate the medical community to consider adopting 3D ultrasound as the first assessment tool for specific gynecologic indications, such as evaluating the uterus for Müllerian anomalies or localization of IUDs or other intracavitary lesions."

The study abstract is available here.