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 T-2* 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 T-2/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 T-2/T2*W imaging (TRICKS: T-2/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 T-2/T2* W imaging and sufficient temporal resolution to distinguish between Grade I, II and III reflux.