Chronic venous disease affects up to 50% of individuals (1-4) Contrasted imaging of pelvic deep venous segments presents multiple challenges Intravascular ultrasonography (IVUS) commonly used as reference standard for vascular intraluminal evaluation Relaxation-Enhanced MR Angiography without Contrast and Triggering (REACT protocol) recently described as non-contrasted, non-invasive option (5) Fig 1 provides a brief overview of contrast-enhanced and unenhanced MR angiography techniques, their principles of imaging and limitations. Contrast-enhanced MR angiography usually involves. intravenous gadolinium and is the gold standard for vascular evaluation using MRI. However,...

Retrospective, single-center, case series Inclusion criteria (REACT protocol MRV and IVUS in our institution between January 2018 and May 2020) Exclusion criteria (prior lower limb venous stenting) Patient demographic, clinical parameters and radiological images reviewed IVUS considered as reference standard (Fig 2). Fig 3 summarizes the chronological methodology of our study.

A total of 244 patients underwent REACT protocol MRV in the specified period. Of this, 33 patients had both REACT protocol MRV and IVUS. This amounted to a total of 110 venous segments available for review. 18 (54.5%) male and 15 female (45.5%) Mean age of 59.0 years (26.0 – 79.5, 12.6 years) Median Body Mass Index 31.1 (range 22.6 – 40.4) 24 patients (72.7%) bilateral involvement 6 patients (18.2%) left, 3 patients (9.1%) right. Fig 4. summaries the various lower limb venous segment stenotic...

In conclusion, this study demonstrates REACT protocol MRV has an excellent sensitivity for the diagnosis of deep pelvic venous stenosis Larger scale studies are warranted to better characterize the inter-rater concordance and diagnostic accuracy of this modality We hope that REACT protocol MRV will one day become a routine screening tool for patients with deep pelvic venous stenosis, and provide patients with a safer, non-invasive cross-sectional imaging option.

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