Objective: The purpose of this study was to compare the diagnostic accuracy of timeresolved MR angiography (TR-MRA) with that of conventional venography for the detection and grading of ovarian venous reflux, which aid in the diagnosis of pelvic venous congestion. Methods: We performed a retrospective analysis of 19 consecutive patients who underwent TR-MRA and conventional venography. The images were analysed by two radiologists in a randomised ''blinded'' manner. With the use of conventional venography as a gold standard, the images were reviewed to determine if differences in the detection and grading of ovarian venous reflux were seen between TR-MRA and conventional venography; the sensitivity, specificity and accuracy of TR-MRA compared with that of conventional venography were evaluated. The McNemar test was performed to determine the significance of any differences. Interobserver agreement was analysed using generalised k statistics. Results: There was no significant difference between TR-MRA and conventional venography for grading ovarian venous reflux (p.0.05). The sensitivity, specificity and diagnostic accuracy of TR-MRA were found to be 66.7%, 100% and 78.9%, and 75%, 100% and 84.2%, respectively, for the two observers. The weighted k-values indicated excellent agreement between the two observers for grading ovarian venous reflux on TR-MRA (k50.894). Conclusion: TR-MRA is an accurate method for accessing pelvic venous congestion.