MRI Study Of Pelvic Veins In Patients With Pelvic Congestion Syndrome And Healthy Women In Their Reproductive Years

Objective: In 1949, Tayor first defined a chronic pelvicpain syndrome as pelvic congestion syndrome. It's gynecologicdisease caused by pelvic varicocele, which happens to parouswomen. Chronic pelvic pain is defined as noncyclic pelvic painwhich lasts at least 6 months. It is a common complaint inwomen, accounting for approximately 10%~40% of allgynecologic visits. It has several causes,including pelvicvarices, and 50% pelvic varices complained of chronic pelvicpain. Pelvic congestion syndrome often is overlooked ormisdiagnosed, because it has complicated clinical features, andhas not differential findings of physical examination. It isimportant to choose appropriate examination which providesexternal proofs for clinical diagnosis. Those examinationsinclude transuterine venography, ovarian venography, CT(Computer Tomography), MRI (Magnetic Resonance Imaging),ultrasonography and so on. Scholars studied the appearance ofpelvic congestion syndrome by different examination techniques,but there were few reports about appearance of pelvic vein inhealthy women in their reproductive years and pelvic congestionsyndrome by MRI. MRI is a noninvasive method, which processis not radiate, and fit for women in their reproductive years. Itcan get images with several scans and sequences, display lesionsroundly and show pelvic organs at the same time. MRA(Magnetic Resonance Angiography) is a new noninvasiveexamination developed in the 1990s', and display vessels inregion of interest clearly without injecting contrast substance. Insome region, it can compare with DSA (Digital SubtractionAngiography). Therefore, this study combined MRI and MRAtechques to investigate MRA techques applying to women; tostudy MRI features of pelvic veins in healthy women in theirreproductive years and patients with pelvic congestionsyndrome, to provide exact and external proofs for diagnosis ofpelvic congestion syndrome, and to familiarize radiologists withanatomy of pelvic veins, the clinical and etiological associationsof pelvic congestion syndrome.Methods and materials: 20 patients with pelviccongestion syndrome, 62 healthy women in their reproductiveyears, including 30 parous women and 32 nonparous women.MRI was performed in 20 patients and 30 parous women within3 days after physical examination and transvaginal sonographyexamination in the Second Hospital of Hebei MedicalUniversity, 32 nonparous women was performed by MRIdirectly in the Second Hospital of Hebei Medical University.MRA was peformed first in them, MRA adoptedtwo-dimensional time of flight(2D-TOF), got resource imagesand MIP (Maximum Intensity Projection) images, then MRI wasperformed. All images including source and MIP imaging wereanalysed in workshop to observe uterus, ovary and parauterineveins, measure the diameter of left ovarian vein and parauterineveins, the thickness of endometrium, observe the number andthe configuration of parauterine veins, analyse statistically, andinvestigate MRI appearance of healthy women in theirreproductive years and patients with pelvic congestionsyndrome.Results:1. The left ovarian veins were seen clearly in all women byMRA. The mean diameter of left ovarian vein was(4.45±0.59)mm in the healthy group, (4.87±0.45)mm in the parous womengroup, (4.06±0.42)mm in the nonparous women group, thediameter of left ovarian in parous women was wider than innonparous women (t=7.297, P<0.001). The mean diameter ofleft ovarian vein was (5.87±1.46)mm in the pelvic congestionsyndrome group, The diameter of left ovarian in pelviccongestion syndrome was wider than in healthy women(t'=4.226, P<0.05) and in parous women (t'=2.959, P<0.05). theright ovarian vein was seen in 5 patients and in 7 healthywomen (4 parous women and 3 nonparous women).2. The mean diameter of parauterine vein was (4.17±0.58)mm in the healthy women group, (4.45±0.48)mm in theparous women group, (3.91±0.54)mm in the nonparous womengroup, the diameter of parauterine vein in parous women waswider than in nonporous women (t=4.122, P<0.001). The meandiameter of parauterine vein was (7.92±1.37)mm in the pelviccongestion syndrome group, the diameter of parauterine vein inpelvic congestion syndrome was wider than in healthy women(t'=11.905, P<0.05) and parous women (t'=10.878, P<0.05).3. Endometrial thickness was (9.64±3.43)mm in the pelviccongestion syndrome group and (6.78±2.42)mm in the healthygroup, and in proliferative phase, endometrial thickness was(5.01±1.60)mm in the healthy group, in secretive phase,endometrial thickness was (8.25±1.95)mm in the healthy group.Endometrium thickness is thicker in patients with pelviccongestion syndrome than in the healthy group (t'=3.462,P<0.05).4. Pelvic veins in 62 healthy women were showed by MRIand MRA, but more clearly by MRA. Pelvic veins in healthywomen appeared as area of absent signal on T1 weighted images(T1WI) and T2 weighted images (T2WI) due to flow voidartifact, and high signal intensity on MRA images, with fewbranch, normal configuration, well-proportioned diameter.5. Varices in patients with pelvic congestion syndrome wasshowed clearly by MRI and MRA, appeared as area of absentsignal on T1WI and T2WI due to flow void artifact, but someappeared hyperintensity or mixed signal intensity on T2WI. OnMRA images, pelvic varices demonstrated high signal intensity.MRI findings of pelvic congestion syndrome were tortuous anddilated parauterine veins with various diameter, the number ofparauterine veins increasing.