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

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.

High-resolution three‑dimensional contrast‑enhanced magnetic resonance venography in children: comparison of gadofosveset trisodium with ferumoxytol

Background Gadofosveset is a gadolinium-based blood pool contrast agent that was approved by the United States Food and Drug Administration in 2008. Its unanticipated withdrawal from production in 2016 created a void in the blood pool agent inventory and highlighted the need for an alternative agent with comparable imaging properties. Objective The purpose of our study is to compare the diagnostic image quality, vascular contrast-to-noise ratio (CNR) and temporal signal characteristics of gadofosveset trisodium and ferumoxytol at similar molar doses for high-resolution, three-dimensional (3-D) magnetic resonance (MR) venography in children. Materials and methods The medical records and imaging data sets of patients who underwent high-resolution 3-D gadofosveset-enhanced MR venography (GE-MRV) or ferumoxytol-enhanced MR venography (FE-MRV) were retrospectively reviewed. Two groups of 20 pediatric patients (age- and weight-matched with one patient common to both groups; age range: 2 days–15 years) who underwent high-resolution 3-D GE-MRV or FE-MRV at similar molar doses were identified and analyzed. Qualitative analysis of image quality and vessel definition was performed by two blinded pediatric radiologists. Interobserver agreement was assessed with the AC1 (first-order agreement coefficient) statistic. Signal-to-noise ratio (SNR) and CNR of the inferior vena cava and aorta were measured in the steady-state venous phase. Medical records were retrospectively reviewed for any adverse reactions associated with either contrast agent. Results Measured SNR and CNR of the inferior vena cava were higher for FE-MRV than GE-MRV (P = 0.034 and P < 0.001, respectively). The overall image quality score and individual vessel scores of FE-MRV were equal to or greater than GE-MRV (P = 0.084), with good interobserver agreement (AC1 = 0.657). The venous signal on FE-MRV was stable over the longest interval measured (1 h, 13 min and 46 s), whereas venous signal on GE-MRV showed more variability and earlier loss of signal. No adverse reactions were noted in any patient with either contrast agent. Conclusion Ferumoxytol produces more uniform and stable enhancement throughout the entire venous circulation in children than gadofosveset, offering a wider time window for optimal image acquisition. FE-MRV offers a near-ideal approach to high-resolution venography in children at all levels of anatomical complexity.

Updates in Magnetic Resonance Venous Imaging

For years, magnetic resonance angiography (MRA) has been a leading imaging modality in the assessment of venous disease involving the pelvis and lower extremities. Current advancement in noncontrast MRA techniques enables imaging of a larger subset of patients previously excluded due to allergy or renal insufficiency, allowing for preintervention assessment and planning. In this article, the current status of MR venography, with a focus on current advancements, will be presented. Protocols and parameters for MR venographic imaging of the pelvis and lower extremities, including contrast and noncontrast enhanced techniques, will be reviewed based on a recent literature review of applied MR venographic techniques. Finally, several disease-specific entities, including pelvic congestion and compression syndromes, will be discussed with a focus on imaging parameters that may best characterize these disease processes and optimize anatomical planning prior to intervention.

State of the venous system in patients with Pseudotumor cerebri

The article describes two clinical cases of idiopathic intracranial hypertension, the first manifestation of which was the development of retroorbital headache and the visual disorders. Leading in the clinical picture of the disease in both cases was the detection of stagnant optic nerve discs on the fundus. In both patients, the vascular system of the brain was examined using duplex scanning of the neck and brain vessels, MR angiography and MR venography, and in one case — SCT angiography, a lumbar puncture was performed with the study of cerebrospinal fluid (CSF). An increase in CSF pressure was found, accompanied by changes in the large venous vessels of the skull and brain. This suggests a significant role of venous outflow disorders in the development of Pseudotumor cerebri syndrome.

Dural Arteriovenous Fistula Formation Secondary to Cerebral Venous Thrombosis: Longitudinal Magnetic Resonance Imaging Assessment Using 4D-Combo-MR-Venography

Background and Purpose Dural arteriovenous fistulae (DAVFs) can develop secondary to cerebral venous thrombosis (CVT). The incidence of DAVF has not yet been investigated prospectively. Methods Between July 2012 and January 2018, combined static and dynamic 4D MR venography (4D-combo-MRV) was performed in 24 consecutive patients at diagnosis of CVT and after 6 months. 3 Tesla magnetic resonance imaging with time of flight and contrast-enhanced magnetization-prepared rapid acquisition with gradient echo were performed at baseline to evaluate the extent of thrombosis and affected vessel segments. Baseline and follow-up 4D-combo-MRV were assessed for signs of DAVF. Interrater reliability of DAVF detection and the extent of recanalization were analyzed with kappa statistics. Results DAVFs were detected in 4/30 CVT patients (13.3%, 95% confidence interval [CI] 3.3–26.7). Two of 24 patients (8.3%, 95% CI: 0–20.8) had coincidental DAVF with CVT on admission. At follow-up, de novo formation of DAVF following CVT was seen in 2/24 patients (8.3%, 95% CI: 0–20.8). Both de novo DAVFs were low grade and benign fistulae (Cognard type 1, 2a), which had developed at previously thrombosed segments. Endovascular treatment was required in two high degree lesions (Cognard 2a + b) detected at baseline and in one de novo DAVF (Cognard 1) because of debilitating headache and tinnitus. Thrombus load, vessel recanalization, and frequency of cerebral lesions (hemorrhage, ischemia) were not associated with DAVF occurrence. Conclusion This exploratory study showed that de novo DAVF formation occurs more frequently than previously described. Although de novo DAVFs were benign, 75% of all detected DAVFs required endovascular treatment. Therefore, screening for DAVF by dynamic MRV, such as 4D-combo-MRV, seems worthwhile in CVT patients.

MRV BRAIN NORMALANATOMICAL VARIANTS IN INDIA POPULATION

Introduction Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations Materials and Methods A retrospective study was conducted in NRI medical college in the Department of Radiodiagnosis for a duration of 3 years to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. Results A total of (46 men, 54 women, age range 12 to 81 years), were included in the study. Most common indication for MR venography was headache (80%). Hypoplastic left transverse sinus was the most common anatomical variation in (25%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to females (13 versus 12). Most common variation of superior sagittal sinus (SSS) was hypoplastic anterior one third SSS ,. Conclusion Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.