Preliminary Study of Noncontrast-Enhanced Magnetic Resonance Imaging for the Diagnosis and Management Iliac Venous Compression Syndrome.

BACKGROUND

The purpose of this study was to determine the technical feasibility and safety of noncontrast-enhanced magnetic resonance imaging (MRI) in the diagnosis and management of iliac vein compression syndrome (IVCS) compared with 3-dimensional rotational venography (3D-RV).

METHODS

The general epidemiological data (including age and gender), clinical manifestations (including major symptom; affected extremity; clinical, etiology, anatomy, and pathophysiology classification; comorbidity; stenosis rate; and Valletta score), and intraoperative findings (collateral vessels present or absent) of 39 IVCS patients who were assessed by both noncontrast-enhanced MRI and 3D-RV between January 2018 and January 2022 were obtained and analyzed.

RESULTS

The iliac vein stenosis rate determined by noncontrast-enhanced MRI and 3D-RV was 79.09 ± 1.57% vs. 80.06 ± 1.62%, respectively (P = 0.13). With the aggravation of Villalta score, the detection rate of both noncontrast-enhanced MRI and 3D-RV for collateral vessels present increased significantly. Compared with 3D-RV, noncontrast-enhanced MRI is more sensitive for the detection of collateral vessels present in early chronic venous disease (P = 0.03). Of these patients, 20 patients were treated with MR images fusion navigation, and 19 patients were treated with 3D venography images fusion navigation during endovascular management. Significant differences were observed between the noncontrast-enhanced MRI and 3D-RV groups concerning X-ray dose (1,695 ± 36.01 mGy vs. 2,820 ± 23.06 mGy; P < 0.001) and contrast agent dosage (49.25 ± 1.02 mL vs. 83.79 ± 2.75 mL; P < 0.001).

CONCLUSION

Noncontrast-enhanced MRI is a quick, efficient, and accurate noninvasive technique for the evaluation and diagnosis of IVCS. In addition to providing the required anatomic information to make the diagnosis of IVCS, it also provides all this intraoperative "roadmap" for possible endovascular management of IVCS.