Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review

Abstract

IntroductionIn the work‐up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non‐invasive diagnostic tools are found to be accurate, invasive venography might no longer be indicated as necessary.Material and methodsA literature search in Pubmed and EMBASE was performed from inception until 6 May 2017. Studies comparing non‐invasive diagnostic tools to a reference standard in the work‐up of patients with (suspected) pelvic congestion syndrome were included. Relevant data were extracted and methodological quality of individual included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool.ResultsNine studies matched our inclusion criteria. Six studies compared ultrasonography to venography and three studies described a magnetic resonance imaging technique. In using transvaginal ultrasonography, the occurrence of a vein greater than five mm crossing the uterine body had a specificity of 91% (95% CI; 77–98%) and occurrence of pelvic varicoceles a sensitivity and specificity of 100% (95% CI; 89–100%) and 83–100% (95% CI; 66–93%), respectively. In transabdominal ultrasonography, reversed caudal flow in the ovarian vein accounted for a sensitivity of 100% (95% CI; 84–100%). Detection of pelvic congestion syndrome with magnetic resonance imaging techniques resulted in a sensitivity varying from 88 to 100%.ConclusionsThe sensitivity of ultrasonography and magnetic resonance imaging seem to be adequate, which indicates a role for both tests in an early stage of the diagnostic workup. However, due to methodological flaws and diversity in outcome parameters, more high standard research is necessary to establish a clear advice for clinical practice.

Tratamento endovascular de síndrome congestiva venosa pélvica em paciente com duplicação de veia cava inferior e anatomia venosa pélvica incomum: revisão bibliográfica

“…The first is valve incompetence caused by congenital absence of valves or presence of dysfunctional valves and the second is the around 60 times increase in pelvic venous capacity during pregnancy, due to mechanical compression by the gravid uterus and the vasodilatory action of progesterone, which can cause incompetence of venous valves, with subsequent venous hypertension and retrograde flow. 2,9 It is estimated that 50% of patients with varicose veins have some type of predisposing genetic component. The FOXC2 gene was the first to be linked with the etiology of varicose veins, playing a key role in development and function of venous valves.…”

Evaluation of Female Pelvic Pain

“…There does appear to be some degree of correlation; however, further prospective studies are needed to further delineate the sensitivity and specificity of these tests for detecting abnormal pelvic vascular patterns. 17 Further study is needed to define the relationship between the findings on imaging and chronic pelvic pain, as there is a paucity of high-powered prospective studies to define pelvic congestion syndrome. Additionally, while various therapies have been tried for pelvic congestion syndrome, the small numbers and lack of prospective randomized studies make it challenging to identify patients who may benefit from these interventions.…”

An Inconvenient Truth: The Added Value of Transvaginal Imaging of the Internal Iliac and Adnexal Veins for Pelvic Congestion Syndrome

“…1 There are three main methods that aid in the diagnosis of PCS. Venography is currently considered the "gold standard" method because by using injection of contrast material, the veins are well defined, and consequently, it is easier to assess Journal for Vascular Ultrasound 43 (3) retrograde fill and congestion of the venous plexus by reflux. However, venography is invasive and exposes premenopausal women to radiation and contrast material.…”