Pelvic venous disorders: Objective hemodynamic signature from quantitative two-dimensional phase-contrast magnetic resonance imaging.

OBJECTIVE

The lack of objective hemodynamic criteria for diagnosing pelvic venous disorders (PeVD) limits interdisciplinary consensus among vascular surgery, radiology, phlebology, and gynecology societies. We applied noncontrast two-dimensional phase-contrast magnetic resonance imaging (2D PC-MRI; QFlow; Medis Medical Imaging Systems B.V.) to quantify pelvic-lower-limb venous flow and assess diagnostic performance.

METHODS

A retrospective cross-sectional study was conducted in 428 women who underwent 2D PC-MRI between 2017 and 2024. Participants included PeVD (n = 138), healthy controls (n = 39), and symptomatic women without PeVD (n = 251). An additional subset of symptomatic women with PeVD who underwent venous intervention (n = 26) was analyzed. Hemodynamic parameters included stroke volume (SV), mean flux (MF), stroke distance (SD), mean velocity (MV), and ankle interstitial pixel-shift signals.

RESULTS

Patients with PeVD demonstrated a consistent hemodynamic signature marked by increased central flow, reduced superficial flow, and left gonadal vein (LGV) reflux. Compared with healthy controls, patients with PeVD had higher right external iliac vein, SV, and MF, lower left great saphenous vein (GSV), SV, and MF, and pronounced LGV abnormalities (SV, 1.29 vs 0.54 mL; MF, 1.50 vs 0.60 cm3/s; SD, -0.50 vs 2.14; MV, -0.49 vs 2.39; all P = .0001). Popliteal vein flow was altered, and ankle signals were elevated. Receiver operating characteristic analysis identified left GSV hypoflow (area under the curve, 0.69-0.71) and LGV SD/MV (area under the curve, ∼0.70-0.71) as the most informative markers.

CONCLUSIONS

Noncontrast 2D PC-MRI yields objective assessment of morphology and segment-specific hemodynamics in lower-body venous system. LGV reflux and GSV hypoflow are the most informative markers of PeVD.