The role of MR venography with time-resolved imaging in diagnosis of pelvic congestion syndrome

Noha M Attia,Mahmoud Ahmed Abdelaleem,Mohamed Abudeif Sayed,Hossam Eldin Galal Mohamed

doi:10.1186/s43055-021-00687-8

Noha M Attia, Mahmoud Ahmed Abdelaleem + Show 2 more

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https://doi.org/10.1186/s43055-021-00687-8

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Abstract

BackgroundPelvic congestion syndrome (PCS) represents a diagnostic challenge due to its variable clinical presentation, complex anatomy, and pathophysiology. Accurate delineation of the venous anatomy, detection of venous reflux or obstruction, its extent will enable interventional radiologists to successfully treat such patients and to avoid recurrence. Magnetic resonance imaging (MRI) allows a noninvasive examination of the anatomy and flow inside the pelvic veins in addition to its excellent soft-tissue contrast allowing evaluation of the pelvic organs. Our study is aiming to investigate the role and accuracy of MR venography with time-resolved imaging (TR-MRV) as a diagnostic tool for pretreatment planning of PCS.ResultsOur study included 25 female patients with mean age 48 ± 12.34, who were referred to the radiology department in the period from April/2019 to April/2020 with clinical and ultrasound features suggesting PCS. TR-MRV was performed and interpreted in a blind fashion evaluating the vascular anatomy, venous dilatation, and reflux. The results were compared to conventional venography as a reference. The sensitivity, specificity, and accuracy of TR-MRV in the detection of ovarian vein reflux were 87%, 80%, and 84%, respectively, versus 75%, 53%, and 72% in internal iliac vein reflux and 92%, 69%, and 64% for pelvic venous plexus reflux. Demonstration of the venous anatomy was excellent in 68% of the patients and was sufficient in 32%. Ovarian vein dilatation was detected in 16 patients by venography and in 10 patients by TR-MRV. The weighted k-values (Cohen's Kappa coefficient statistics) indicated excellent agreement between the two observers for identifying all the refluxing veins by TRI in each patient (k = 0.78).ConclusionMRI with TR imaging has shown high diagnostic accuracy when compared to conventional venography in evaluating pelvic congestion syndrome before endovascular treatment and thus facilitating treatment planning.

Highlights

Pelvic congestion syndrome (PCS) represents a diagnostic challenge due to its variable clinical presentation, complex anatomy, and pathophysiology
This study aims to evaluate the role and accuracy of Time-resolved. Magnetic resonance venography (TR-Magnetic resonance venography (MRV)) in the diagnostic work-up of pelvic congestion syndrome before endovascular treatment
One patient was diagnosed by both modalities with pelvic venous insufficiency (PVI) secondary to May–Thurner syndrome (Fig. 1)

Summary

Introduction

Pelvic congestion syndrome (PCS) represents a diagnostic challenge due to its variable clinical presentation, complex anatomy, and pathophysiology. Pelvic congestion syndrome (PCS) is a complex, underdiagnosed cause of chronic pelvic pain in female patients. Up to 38 out of 1,000 women annually present in primary care with intermittent or constant pain in the lower abdomen or pelvis, a rate comparable with that of Asthma. Multiple etiologies may be responsible for Pelvic Congestion Syndrome. PCS caused by incompetent gonadal vein valves is termed pelvic venous insufficiency (PVI) [4]. Most women present with non-cyclic, intermittent, constant pelvic pain for more than 6 months. Pelvic venous engorgement and gonadal vein reflux can be seen in patients without pelvic pain. The diagnosis of pelvic congestion syndrome is made based on the patient’s symptoms, clinical examination, and imaging studies

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