From the Guidelines
MRI is the preferred imaging modality for evaluating pelvic congestion syndrome, as it can effectively demonstrate pelvic varices and ovarian vein reflux, with a diagnostic performance comparable to conventional venography. The use of MRI for this indication is growing, and it has largely supplanted conventional venography for diagnostic purposes 1. When MRI is clinically indicated, the use of a gadolinium-based IV contrast agent is preferred, and T2-weighted imaging has the capacity to demonstrate pelvic varices, but signal intensity varies with flow velocity 1.
Some key benefits of using MRI to evaluate pelvic congestion syndrome include:
- Excellent soft tissue contrast, which allows for clear visualization of dilated pelvic veins
- Assessment of venous flow, which can help identify ovarian vein reflux
- Ability to identify alternative causes of pelvic pain
- Avoidance of radiation exposure, which is important since pelvic congestion syndrome primarily affects women of reproductive age
The preferred protocol for MRI evaluation of pelvic congestion syndrome includes:
- T1 and T2-weighted sequences with fat suppression
- Contrast-enhanced MR venography
- Scanning patients in both supine and upright positions if possible, as venous dilation may be more pronounced when standing
- Detection of key diagnostic findings, including dilated ovarian veins, tortuous arcuate veins in the myometrium, and congested parauterine venous plexuses 1.
From the Research
Evaluation of Pelvic Congestion Syndrome with MRI
- Pelvic congestion syndrome (PCS) can be evaluated using MRI, as it is a non-invasive tool that can help in the diagnosis and management of the condition 2, 3, 4.
- MRI can detect pelvic venous congestion, ovarian vein reflux, and varicose veins, which are common findings in PCS 3, 4.
- The sensitivity of MRI in detecting PCS is high, with a sensitivity of 96% reported in one study 2.
- MRI can also help identify local pelvic obstructing causes, vascular compression syndrome, and primary non-obstructing PCS, which can aid in decision-making for treatment 2.
- Time-resolved MR angiography can demonstrate early retrograde ovarian vein filling and multiple dilated pelvic varices, allowing for the prospective diagnosis of PCS 3.
- MR venography has been shown to have high sensitivity in evaluating patients with suspected pelvic venous congestion, with a sensitivity of 88-100% reported in one study 4.
Advantages of MRI in Evaluating PCS
- MRI is a non-invasive tool that can help reduce the need for invasive venography 2, 3, 4.
- MRI can provide detailed images of the pelvic anatomy, including the ovarian veins and varicose veins 3, 4.
- MRI can help identify the underlying cause of PCS, which can aid in decision-making for treatment 2.