MRI and transvaginal doppler ultrasound in evaluation of pelvic congestion syndrome

Background Pelvic congestion syndrome involves pelvic venous incompetence, characterized by dilated ovarian/para-uterine veins, sluggish/retrograde blood flow, and reflux. Symptoms include chronic pelvic pain, dysmenorrhea, dyspareunia, and menorrhagia, often coexisting with varicose veins and polycystic ovaries (≥40% of cases) due to hormonal influences and multiparity. Aim We aimed to assess the role of MRI and transvaginal ultrasound (TVUS) with Doppler in diagnosing pelvic congestion syndrome. Patients and methods This case-control study included 30 symptomatic females (cases) and 60 asymptomatic controls referred to the Radiodiagnosis and Medical Imaging Department from the Obstetrics and Gynecology Department of our institute (February 2022–2023). All participants underwent TVUS with Doppler. MRI was performed for all cases and 10 controls with incidental pelvic varicosities on TVUS. Results Multiparity was the predominant risk factor (60% of cases), with chronic pelvic pain as the chief complaint (53.3%). TVUS demonstrated excellent diagnostic accuracy for pelvic vein dilatation (area under the curve: 0.947) and MRI showed strong performance (area under the curve: 0.864). The left pelvic vein’s mean diameter was 6.7±0.81 mm TVUS, 6.6±0.84 mm MRI, and 6.6±0.84 mm operative; right-sided measurements were 4.7±0.78 mm TVUS, 4.6±0.75 mm MRI, and 4.6±0.77 mm operative. MRI provided superior precision in vein diameter assessment compared with TVUS. Conclusions TVUS with Doppler is preferred for detecting pelvic vein dilatation due to its ability to visualize the venous plexus and analyze blood flow dynamics. MRI is crucial for accurately determining vein diameter, selecting appropriate treatment, and identifying obstructions and external vein compressions.