Lesion-specific comparison of pelvic venous ultrasound, dynamic magnetic resonance venography and digital subtraction venography in pelvic vein disorders

OBJECTIVE: To compare the diagnostic performance of venous doppler ultrasound (DUS) and dynamic magnetic resonance venography (dMRV) with digital subtraction venography (DSV) venography in the assessment of anatomical lesions associated with pelvic vein disorders (PeVD). METHODS: Forty women with symptoms of PeVD indicated for endovascular surgical treatment were included in this study. Patients were investigated using DUS and dynamic venous dMRV to assess gonadal vein reflux, internal iliac vein reflux, left renal vein stenosis, and left common iliac vein stenosis. Intraoperative phlebography images, considered the gold standard, were compared to DUS and MRI to assess the level of agreement using Cohen's kappa coefficient. Sensitivity, specificity, predictive values, and overall accuracy were calculated for DUS and dMRV. RESULTS: No significant agreement was identified between either DUS or dMRV and DSV for grading LRV stenosis (κ = 0.031, p-value: 0.736 for DUS; and κ = 0.146, p-value: 0.151 for dMRV). For LCIV stenosis, DUS showed moderate agreement, whereas dMRV demonstrated no meaningful concordance (κ = 0.490; p < .001 for DUS; and κ = 0.211; p = 0.056 for dMRV). In contrast, substantial to excellent agreement with DSV was observed for gonadal vein reflux using dMRV (κ = 0.806; p < .001) and moderate agreement using DUS (κ = 0.500; p < .001). Neither modality reliably assessed internal iliac vein reflux. Direct comparison between DUS and dMRV showed moderate agreement for gonadal reflux and LRV stenosis, and fair agreement for LCIV stenosis. For detecting gonadal reflux, DUS demonstrated a sensitivity of 100% and dMRV of 93.3%, both with high specificity. Sensitivity for internal iliac vein reflux was low, though specificity remained high for both modalities. CONCLUSION: DUS and dMRV demonstrated strong concordance with DSV in detecting gonadal vein reflux. DUS and dMRV are suboptimal imaging modalities in the evaluation of LRV and CIV stenosis. Both DUS and dMRV are unreliable in the detection of internal iliac vein reflux.