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

Abstract Background Pelvic 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. Results Our 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). Conclusion MRI 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.

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Successful ultrasound-guided foam sclerotherapy for vulval and leg varicosities secondary to ovarian vein reflux: a case study

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2009.009086 ◽

2010 ◽

Vol 26 (1) ◽

pp. 29-31 ◽

Cited By ~ 16

Author(s):

P Paraskevas

Keyword(s):

Varicose Veins ◽

Duplex Ultrasound ◽

Symptomatic Improvement ◽

Ovarian Vein ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Pelvic Congestion Syndrome ◽

Vein Reflux ◽

Pelvic Congestion

Pelvic varicose veins secondary to ovarian vein reflux are common and can present with clinical pelvic congestion syndrome (PCS). After assessment with duplex ultrasound and venography, treatment often involves surgical ovarian vein ligation and more recently embolization of the ovarian vein(s) followed by ultrasound-guided foam sclerotherapy (UGFS) of the pelvic tributaries. This paper presents one out of many PCS patients treated with UGFS of the pelvic tributaries alone, with clinically symptomatic improvement.

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Time-resolved imaging of contrast kinetics three-dimensional (3D) magnetic resonance venography in patients with pelvic congestion syndrome

British Journal of Radiology ◽

10.1259/bjr/82417499 ◽

2010 ◽

Vol 83 (994) ◽

pp. 882-887 ◽

Cited By ~ 12

Author(s):

E A Dick ◽

C Burnett ◽

A Anstee ◽

M Hamady ◽

D Black ◽

...

Keyword(s):

Magnetic Resonance ◽

Three Dimensional ◽

Magnetic Resonance Venography ◽

Time Resolved ◽

Pelvic Congestion Syndrome ◽

Time Resolved Imaging ◽

Pelvic Congestion

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Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches

VASA ◽

10.1024/0301-1526/a000538 ◽

2016 ◽

Vol 45 (4) ◽

pp. 275-282 ◽

Cited By ~ 8

Author(s):

Christina Jeanneret ◽

Konstantin Beier ◽

Alexander von Weymarn ◽

Jürg Traber

Keyword(s):

Varicose Veins ◽

Left Renal Vein ◽

Standing Position ◽

Ovarian Vein ◽

Pelvic Congestion Syndrome ◽

Compression Syndrome ◽

Abstract Knowledge ◽

Increased Risk ◽

Definition Of ◽

Pelvic Congestion

Abstract. Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.

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Ovarian Vein Embolization for the Treatment of Postmenopausal Pelvic Congestion Syndrome

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2008.09.490 ◽

2008 ◽

Vol 15 (6) ◽

pp. 135S

Author(s):

S.K. Jung ◽

C.Y. Huh ◽

Y.J. Choi ◽

N.H. Jung

Keyword(s):

Ovarian Vein ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Pelvic Congestion Syndrome: Systematic Review of Treatment Success

Seminars in Interventional Radiology ◽

10.1055/s-0038-1636519 ◽

2018 ◽

Vol 35 (01) ◽

pp. 035-040 ◽

Cited By ~ 11

Author(s):

Magda Rizer ◽

Ryan Alexander ◽

Emerson Sharpe ◽

Paul Rochon ◽

Candace Brown

Keyword(s):

United States ◽

Systematic Review ◽

Venous Insufficiency ◽

Clinical Symptoms ◽

Treatment Success ◽

Percutaneous Treatment ◽

The United States ◽

Pelvic Congestion Syndrome ◽

Venous Dilatation ◽

Pelvic Congestion

AbstractPelvic venous insufficiency is now a well-characterized etiology of pelvic congestion syndrome (PCS). The prevalence of CPP is 15% in females aged 18 to 50 years in the United States and up to 43.4% worldwide. In addition to individual physical, emotional, and quality-of-life implications of CPP, there are profound healthcare and socioeconomic expenses with estimated annual direct and indirect costs in the United States in excess of 39 billion dollars. PCS consists of clinical symptoms with concomitant anatomic and physiologic abnormalities originating in venous insufficiency. The etiology of PCS is diverse involving both mechanical and hormonal factors contributing to venous dilatation (>5 mm) and insufficiency. Factors affecting the diagnosis of PCS include variance of causes and clinical presentations of pelvic pain and relatively low sensitivity of noninvasive diagnostic imaging and laparoscopy to identify insufficiency compared with catheter venogram. A systematic review of the literature evaluating patient outcomes following percutaneous treatment of PCS is presented.

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