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

The purpose of this study was to assess the role of magnetic resonance venography (MRV) with time-resolved imaging of contrast kinetics (TRICKS) in dynamically evaluating ovarian vein dilation, reflux and direction of flow in patients with suspected pelvic congestion syndrome (PCS). The hypotheses tested were: (i) That conspicuity scores of the ovarian veins across three raters was greater using TRICKS MRV compared with T2W or T₂* imaging; (ii) That three key MR variables (ovarian vein diameter, timing and grade of reflux) correlated across all raters. We carried out a retrospective study of 13 patients undergoing T2W and TRICKS MRI and pelvic sonography (n = 4) or catheter venography (n = 5). Three observers rated conspicuity, vessel diameter, timing and grade of ovarian vein reflux for T₂/T2*W and TRICKS MRI. The mean left ovarian diameter for all patients with reflux was 7.9 mm (range 2.2–12 mm). There was high inter-observer agreement for ovarian vein diameter for both sequences. TRICKS showed significantly greater conspicuity than T₂/T2*W imaging (TRICKS: T₂/T2* mean (SD) = 7.80 (3.20):5.50 (1.97), F (1,12) = 5.80, p< 0.05). TRICKS MRV demonstrated high inter-observer correlation for timing and grade of reflux (r (36) = 0.77,0.71,0.79, p < 0.01). TRICKS MRA/V was significantly degraded by breathing artefact in two patients. We conclude that TRICKS MRV accurately and dynamically demonstrates ovarian vein reflux in patients with PCS but requires quiet respiration. TRICKS MRV has better image conspicuity than T₂/T2*W imaging and sufficient temporal resolution to distinguish between Grade I, II and III reflux.The purpose of this study was to assess the role of time-resolved imaging of contrast kinetics magnetic resonance venography (TRICKS MRV) in dynamically evaluating ovarian vein dilation, reflux and direction of flow in patients with suspected pelvic congestion syndrome (PCS). PCS is the presence of long-standing pelvic pain due to a variety of causes, including ovarian vein incompetence [1]. The most important aetiological factor is parity, which is associated with ovarian vein dilation and valvular incompetence in 50–73% of women; although it is important to note that not all women with ovarian vein incompetence are symptomatic [1–3]. In women whose PCS is caused by ovarian vein incompetence, surgical ligation or transcatheter ovarian vein embolisation can be successful [4, 5]. To select patients suitable for surgical or interventional therapy, the ideal diagnostic technique has high spatial and temporal resolution, is non-invasive and does not involve ionising radiation. One such technique may be TRICKS MRV, a modified 3D fast gradient echo (GRE) pulse sequence [6]. Here we evaluate the role of TRICKS MRV in assessing ovarian veins, including image conspicuity, spatial and temporal resolution.