Type:
Educational Exhibit
Keywords:
Vascular, Pelvis, Veins / Vena cava, MR, MR-Angiography, Diagnostic procedure, Technical aspects, Varices, Haemodynamics / Flow dynamics
Authors:
S. Wassef, A. Stolpen; Iowa City, IA/US
DOI:
10.1594/ecr2018/C-2652
Conclusion
Primary pelvic congestion syndrome (PCS),
the female counterpart of male varicocele,
is caused by incompetence of the ovarian vein,
usually on the left side and often in combination with “nutcracker-like” compression of the left renal vein.
The ovarian vein reflux leads to pelvic vein engorgement.
However,
the imaging findings must be correlated with symptoms of chronic pelvic pain to render a diagnosis of PCS.
Although non-invasive imaging techniques,
such as ultrasound,
CT and static MRI,
can be helpful in patients with suspected PCS,
they cannot reliably determine the timing and direction of venous blood flow in renal,
ovarian and pelvic veins,
all of which are essential for diagnosis and treatment planning.
Conventional angiography has been considered the gold standard for diagnosis and offers the possibility of concurrent ovarian vein embolization therapy.
Recently,
time-resolved contrast-enhanced 3D MR angiography (TR-MRA) has demonstrated its utility and reliability for identifying ovarian vein reflux and pelvic varices.
In patients with suspected PCS,
TR-MRA provides an acceptable tradeoff between temporal and spatial resolution,
which enables depiction of arterial phase,
mixed phase and venous phase vascular imaging during passage of the contrast bolus through the lower abdominal and pelvic venous system.
And unlike CT and static MRI,
TR-MRA can demonstrate ovarian vein reflux with subsequent retrograde filling of periuterine varices.
Lastly,
the combination of TR-MRA and static pelvic MRI can depict detailed pelvic anatomy and offer clues to alternative causes of chronic pelvic pain.