ACR Appropriateness Criteria® Radiologic Management of Uterine Leiomyomas

J Am Coll Radiol. 2018 May;15(5S):S160-S170. doi: 10.1016/j.jacr.2018.03.010.


Uterine fibroids, also known as leiomyomas, are the most common benign tumor in women of reproductive age. When symptomatic, these patients can present with bleeding and/or bulk-related symptoms. Treatment options for symptomatic uterine leiomyomas include medical management, minimally invasive treatment such as uterine artery embolization, and surgical options, such as myomectomy. It is important to understand the role of these treatment options in various clinical scenarios so that appropriate consultation is performed. Furthermore, patients should be presented with the outcomes and complications of each of these treatment options. A summary of the data and clinical trials of the treatment options for symptomatic uterine leiomyomas is outlined in this article. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Keywords: AUC; Appropriate Use Criteria; Appropriateness Criteria; Endometrial ablation; Fibroids and fertility; MRgFUS; Myomectomy/hysterectomy; Uterine artery embolization; Uterine leiomyoma.

Publication types

  • Practice Guideline

MeSH terms

  • Adolescent
  • Adult
  • Evidence-Based Medicine
  • Female
  • Humans
  • Leiomyoma / diagnostic imaging*
  • Leiomyoma / therapy*
  • Middle Aged
  • Societies, Medical
  • United States
  • Uterine Neoplasms / diagnostic imaging*
  • Uterine Neoplasms / therapy*