Ovarian veins: Magnetic resonance imaging findings in an asymptomatic population

Abstract

Purpose: To evaluate the magnetic resonance (MR) venographic appearance of the ovarian veins in a healthy population, correlated with surgical findings. Our data can be used as a basis for comparison to patients with suspected pelvic congestion syndrome (PCS). Materials and Methods:We retrospectively reviewed exams of 22 women who had MR angiography for potential renal donation evaluation (age range, 19.3-60.5 years; mean, 38 years). We evaluated the diameter of the ovarian veins on dynamic multiphasic postcontrast coronal images, the phase of contrast appearance in these veins, the apparent direction of flow, and the presence of ovarian or pelvic varices. Surgical correlation was obtained in 12 patients. Clinical charts were reviewed and patients were asked about symptoms of chronic pelvic pain and the number of their children. Results:Of the 22 exams, 21 left gonadal veins were identified. Passive reflux from the left renal vein into the left gonadal vein was suggested in eight exams (38%). These veins had a mean diameter of 6.4 Ϯ 1.6 mm, significantly larger than 4.5 Ϯ 1.3 mm for the other 13 left gonadal veins without reflux (P Ͻ 0.005). The right gonadal vein was identified in 8 of 22 women, with a mean diameter of 4.4 Ϯ 0.5 mm. No patient reported symptoms of chronic pelvic pain. Conclusion:Passive reflux from the left renal vein to the left gonadal vein can occur in asymptomatic women. Diagnosis of PCS depends heavily on appropriate clinical history.

Ovarian vein diameters measured by MDCT in women without evidence of pelvic congestion syndrome

“…Our findings are in concordance with previous MDCT study that investigated relationship between ROV variance with pelvic varices and reported similar mean diameters of ROVs and LOVs in parous and nulliparous women without pelvic varices (9). However, another study reported a larger ovarian vein sizes (ROV 4.4 (0.5) mm, LOV 5.2 (1.0) mm) measured by the magnetic resonance imaging.…”

“…The etiology of the primary PCS seems to be related to the reflux in the incompetent and dilated ovarian veins despite the high prevalence of ovarian vein dilatation and reflux among asymptomatic multiparous women (6)(7)(8)(9)(10). The etiology of secondary PCS is related to underlying abnormalities, resulting in increased pressure in the abdominal and pelvic veins, which transmits retrograde to the pelvic venous system resulting in the pelvic congestion (11)(12).…”

“…There are no cross-sectional imaging studies that reported data regarding to the reference values for ovarian veins size in healthy population. Only few published reports mentioned ovarian vein diameters measured by MDCT or magnetic resonance imaging in symptomatic or asymptomatic patients selected as control group with a relatively small sample size (7,9,16,17). Multidetector computed tomography is a commonly used diagnostic modality to investigate patients presented with abdominal or pelvic pain.…”

Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography

“…However, we did not use a control group in this study and this may be another limitation of this study. Finally, ovarian venous reflux by itself is not enough to make the diagnosis of pelvic venous congestion because reflux into the left ovarian vein and the associated parauterine veins is often seen in asymptomatic multiparous females [18,19]. However, we believe that our patients could be diagnosed as having pelvic congestion syndrome because our patients had chronic pelvic pain of at least 6 months' duration and they had no definite pelvic lesion such as adenomyosis, huge uterine myomas or endometriosis on pelvic MRI.…”

“…However, sonography does not readily show the ovarian veins. On the static CT and MR images, pelvic venous congestion was revealed as ovarian vein dilatation and early filling of the ovarian veins and dilated, tortuous, enhancing tubular structures near the ovaries and uterus [7,10,18]. However, the accurate determination of the direction of flow in the ovarian veins is difficult on the static CT and MR images.…”