Download PDF
CC BY-NC-ND 4.0 · Ultraschall Med 2024; 45(06): 597-603
DOI: 10.1055/a-2263-7193
Review

Noninvasive diagnostic imaging of pelvic venous disorders

Nicht invasive diagnostische Bildgebung von Beckenvenen-Erkrankungen
Filip Szkodziak 
1   3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland (Ringgold ID: RIN49554)
,
Slawomir Wozniak
1   3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland (Ringgold ID: RIN49554)
,
Piotr Robert Szkodziak 
1   3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland (Ringgold ID: RIN49554)
,
Krzysztof Pyra
2   Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland (Ringgold ID: RIN49554)
,
Tomasz Paszkowski
1   3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland (Ringgold ID: RIN49554)
› Author AffiliationsSupported by: Uniwersytet Medyczny w Lublinie 329
› Further Information
Also available at
   Permissions and Reprints

Abstract

It is estimated that chronic pelvic pain (CPP) may affect up to 24% of women. Unfortunately, very often, despite extensive diagnostics, the cause of CPP remains unknown. The pathophysiology of CPP could be explained to a large extent by the occurrence of pelvic venous disorders (PVD). Although pelvic venography is still considered the gold standard for the diagnosis of PVD, noninvasive diagnostic imaging techniques seem to be instrumental in the initial identification of patients with PVD. This literature review aimed to analyze and evaluate the usefulness of noninvasive diagnostic imaging techniques like transvaginal ultrasonography, transabdominal ultrasonography, magnetic resonance, and computed tomography in the diagnosis and identification of patients with PVD. Forty-one articles published between 1984 and 2023 were included in this literature review. Based on this literature review, we conclude that the clinical application of noninvasive diagnostic techniques in the diagnosis of PVD seems to be very promising. Future studies investigating the role of noninvasive diagnostic imaging techniques in the diagnosis of PVD are required.

Zusammenfassung

Schätzungen zufolge sind bis zu 24% aller Frauen von chronischen Beckenschmerzen (CPP: „Chronic Pelvic Pain“) betroffen. Leider bleibt die Ursache von CPP trotz umfassender Diagnostik sehr oft unbekannt. Die Pathophysiologie von CPP könnte zu einem großen Teil durch das Auftreten von Beckenvenen-Erkrankungen (PVD: „Pelvic Venous Disorders“) erklärt werden. Obwohl die Beckenvenografie nach wie vor als Goldstandard für die Diagnose der PVD gilt, scheinen nicht invasive diagnostische Bildgebungstechniken bei der Erstidentifizierung von Patienten mit PVD hilfreich zu sein.

Diese Literaturrecherche zielte darauf ab, den Nutzen nicht invasiver diagnostischer Bildgebungstechniken wie transvaginaler Ultraschall, transabdominaler Ultraschall, Magnetresonanztomografie und Computertomografie bei der Diagnose und Identifizierung von Patienten mit PVD zu analysieren und zu bewerten.

In diese Literaturübersicht wurden 41 Artikel einbezogen, die zwischen 1984 und 2023 veröffentlicht wurden. Basierend auf dieser Literaturrecherche kommen wir zu dem Schluss, dass die klinische Anwendung nicht invasiver Diagnosetechniken bei der Diagnose von PVD sehr vielversprechend zu sein scheint.

Zukünftige Studien, die die Rolle nicht invasiver diagnostischer Bildgebungstechniken bei der Diagnose von PVD untersuchen, sind erforderlich.

Keywords

Pelvic Venous Disorders - Chronic Pelvic Pain - Ultrasonography - MRI - Noninvasive diagnostic imaging


Publication History

Received: 16 April 2023

Accepted after revision: 25 January 2024

Accepted Manuscript online:
07 February 2024

Article published online:
06 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Royal College of Obstetricians and Gynaecologists. The initial management of chronic pelvic pain: Green Top Guideline No. 41. (May 2012). Accessed October 13, 2022 at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_41.pdf
    PubMed
  • 2 Khilnani NM, Winokur RS, Scherer KL. et al. Clinical Presentation and Evaluation of Pelvic Venous Disorders in Women. Tech Vasc Interv Radiol 2021; 24 (01) 100730
    CrossrefPubMedSearch in Google Scholar
  • 3 Phillips D, Deipolyi AR, Hesketh RL. et al. Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol 2014; 25 (05) 725-733
    CrossrefPubMedSearch in Google Scholar
  • 4 Meissner MH, Khilnani NM, Labropoulos N. et al. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord 2021; 9 (03) 568-584
    CrossrefPubMedSearch in Google Scholar
  • 5 Zondervan KT, Yudkin PL, Vessey MP. et al. The community prevalence of chronic pelvic pain in women and associated illness behaviour. Br J Gen Pract 2001; 51 (468) 541-547
    PubMedSearch in Google Scholar
  • 6 Latthe P, Latthe M, Say L. et al. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006; 6: 177
    CrossrefPubMedSearch in Google Scholar
  • 7 Borghi C, Dell’Atti L. Pelvic congestion syndrome: the current state of the literature. Arch Gynecol Obstet 2016; 293 (02) 291-301
    CrossrefPubMedSearch in Google Scholar
  • 8 Szymanski J, Jakiel G, Slabuszewska-Jozwiak A. Pelvic venous insufficiency – an often-forgotten cause of chronic pelvic pain. Ginekol Pol 2020; 91 (11) 704-708
    CrossrefPubMedSearch in Google Scholar
  • 9 Xholli A, Londero AP, Cavalli E. et al. The Benefit of Transvaginal Elastography in Detecting Deep Endometriosis: A Feasibility Study. Ultraschall in Med 2023;
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Cohen Ben-Meir L, Soriano D, Zajicek M. et al. The Association Between Gastrointestinal Symptoms and Transvaginal Ultrasound Findings in Women Referred for Endometriosis Evaluation: A Prospective Pilot Study. Ultraschall in Med 2022; 43 (05) e81-e89
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Beard RW, Highman JH, Pearce S. et al. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet 1984; 2: 946-949
    CrossrefPubMedSearch in Google Scholar
  • 12 Clark MR, Taylor AC. Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment. Semin Intervent Radiol 2023; 40 (04) 362-371
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Tanaka ME, Kutsenko O, Salazar G. Choosing the Most Appropriate Treatment Option for Pelvic Venous Disease: Stenting versus Embolization. Semin Intervent Radiol 2021; 38 (02) 182-188
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Arnoldussen CW, de Wolf MA, Wittens CH. Diagnostic imaging of pelvic congestive syndrome. Phlebology 2015; 30 (Suppl. 01) 67-72
    CrossrefPubMedSearch in Google Scholar
  • 15 Herrera-Betancourt AL, Villegas-Echeverri JD, López-Jaramillo JD. et al. Sensitivity and specificity of clinical findings for the diagnosis of pelvic congestion syndrome in women with chronic pelvic pain. Phlebology 2018; 33 (05) 303-308
    CrossrefPubMedSearch in Google Scholar
  • 16 Hansrani V, Dhorat Z, McCollum CN. Diagnosing of pelvic vein incompetence using minimally invasive ultrasound techniques. Vascular 2017; 25 (03) 253-259
    CrossrefPubMedSearch in Google Scholar
  • 17 Valero I, Garcia-Jimenez R, Valdevieso P. et al. Identification of Pelvic Congestion Syndrome Using Transvaginal Ultrasonography. A Useful Tool. Tomography 2022; 8 (01) 89-99
    CrossrefPubMedSearch in Google Scholar
  • 18 Knuttinen MG, Xie K, Jani A. et al. Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues. AJR Am J Roentgenol 2015; 204 (02) 448-458
    CrossrefPubMedSearch in Google Scholar
  • 19 Park SJ, Lim JW, Ko YT. et al. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol 2004; 182 (03) 683-688
    CrossrefPubMedSearch in Google Scholar
  • 20 Topper SR, Winokur RS. Imaging of Pelvic Venous Disorders (PeVD); Should Every Patient Get an MRI?. Tech Vasc Interv Radiol 2021; 24 (01) 100731
    CrossrefPubMedSearch in Google Scholar
  • 21 Whiteley MS, Dos Santos SJ, Harrison CC. et al. Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Phlebology 2015; 30 (10) 706-713
    CrossrefPubMedSearch in Google Scholar
  • 22 Labropoulos N, Jasinski PT, Adrahtas D. et al. A standardized ultrasound approach to pelvic congestion syndrome. Phlebology 2017; 32 (09) 608-619
    CrossrefPubMedSearch in Google Scholar
  • 23 Steenbeek MP, van der Vleuten CJM, Schultze Kool LJ. et al. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. Acta Obstet Gynecol Scand 2018; 97 (07) 776-786
    CrossrefPubMedSearch in Google Scholar
  • 24 Dos Santos SJ, Holdstock JM, Harrison CC. et al. Ovarian Vein Diameter Cannot Be Used as an Indicator of Ovarian Venous Reflux. Eur J Vasc Endovasc Surg 2015; 49 (01) 90-94
    CrossrefPubMedSearch in Google Scholar
  • 25 Metzger PB, Rossi FH, Kambara AM. et al. Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound. J Vasc Surg Venous Lymphat Disord 2016; 4 (01) 18-27
    CrossrefPubMedSearch in Google Scholar
  • 26 Kim SH, Cho SW, Kim HD. et al. Nutcracker syndrome: diagnosis with Doppler US. Radiology 1996; 198 (01) 93-97
    CrossrefPubMedSearch in Google Scholar
  • 27 Malgor RD, Adrahtas D, Spentzouris G. et al. The role of duplex ultrasound in the workup of pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord 2014; 2 (01) 34-38
    CrossrefPubMedSearch in Google Scholar
  • 28 Lombardi P, Carr JC, Allen BD. et al. Updates in Magnetic Resonance Venous Imaging. Semin Intervent Radiol 2021; 38 (02) 202-208
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Kim CY, Miller Jr MJ, Merkle EM. Time-resolved MR angiography as a useful sequence for assessment of ovarian vein reflux. AJR Am J Roentgenol 2009; 193 (05) W458-463
    CrossrefPubMedSearch in Google Scholar
  • 30 Yang DM, Kim HC, Nam DH. et al. Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography. Br J Radiol 2012; 85: e117-122
    CrossrefPubMedSearch in Google Scholar
  • 31 Dick EA, Burnett C, Anstee A. et al. Time-resolved imaging of contrast kinetics three-dimensional (3D) magnetic resonance venography in patients with pelvic congestion syndrome. Br J Radiol 2010; 83: 882-887
    CrossrefPubMedSearch in Google Scholar
  • 32 Asciutto G, Mumme A, Marpe B. et al. MR venography in the detection of pelvic venous congestion. Eur J Vasc Endovasc Surg 2008; 36 (04) 491-496
    CrossrefPubMedSearch in Google Scholar
  • 33 Ganeshan A, Upponi S, Hon LQ. et al. Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol 2007; 30 (06) 1105-1111
    CrossrefPubMedSearch in Google Scholar
  • 34 Osman AM, Mordi A, Khattab R. Female pelvic congestion syndrome: how can CT and MRI help in the management decision?. Br J Radiol 2021; 94: 20200881
    CrossrefPubMedSearch in Google Scholar
  • 35 Desimpelaere JH, Seynaeve PC, Hagers YM. et al. Pelvic congestion syndrome: demonstration and diagnosis by helical CT. Abdom Imaging 1999; 24 (01) 100-102
    CrossrefPubMedSearch in Google Scholar
  • 36 Kim KW, Cho JY, Kim SH. et al. Diagnostic value of computed tomographic findings of nutcracker syndrome: correlation with renal venography and renocaval pressure gradients. Eur J Radiol 2011; 80 (03) 648-654
    CrossrefPubMedSearch in Google Scholar
  • 37 Baldt MM, Zontsich T, Stümpflen A. et al. Deep venous thrombosis of the lower extremity: efficacy of spiral CT venography compared with conventional venography in diagnosis. Radiology 1996; 200 (02) 423-428
    CrossrefPubMedSearch in Google Scholar
  • 38 Kowalczyk K, Kowalczyk D, Klimek M. et al. A comprehensive use of ultrasound examination in infertility workup. Ginekol Pol 2021;
    CrossrefPubMedSearch in Google Scholar
  • 39 Watanabe Y, Dohke M, Okumura A. et al. Dynamic subtraction contrast-enhanced MR angiography: technique, clinical applications, and pitfalls. Radiographics 2000; 20 (01) 135-152
    CrossrefPubMedSearch in Google Scholar
  • 40 Pandey T, Shaikh R, Viswamitra S. et al. Use of time resolved magnetic resonance imaging in the diagnosis of pelvic congestion syndrome. J Magn Reson Imaging 2010; 32 (03) 700-704
    CrossrefPubMedSearch in Google Scholar
  • 41 Huang YK, Tseng YH, Lin CH. et al. Evaluation of venous pathology of the lower extremities with triggered angiography non-contrast-enhanced magnetic resonance imaging. BMC Med Imaging 2019; 19 (01) 96
    CrossrefPubMedSearch in Google Scholar