Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy

• Published in: Thrombosis research 2010-08, Vol.126 (2), p.107-112
• Main Authors: Torkzad, Michael R, Bremme, Katarina, Hellgren, Margareta, Eriksson, Maria J, Hagman, Anna, Jörgensen, Trine, Lund, Kent, Sandgren, Gunnel, Blomqvist, Lennart, Kälebo, Peter
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Hematology, Oncology and Palliative Medicine; Humans; Magnetic Resonance Imaging; Magnetic resonance imaging (MRI); MEDICAL AND HEALTH SCIENCES; Medical sciences; MEDICIN; MEDICIN OCH HÄLSOVETENSKAP; MEDICINE; Middle Aged; Pelvis - diagnostic imaging; Pelvis - pathology; Pregnancy; Pregnancy Complications, Cardiovascular - diagnosis; Pregnancy Complications, Cardiovascular - diagnostic imaging; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Ultrasonography; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; venous thrombosis; Venous Thrombosis - complications; Venous Thrombosis - diagnosis; Venous Thrombosis - diagnostic imaging; Young Adult
• ISSN: 0049-3848; 1879-2472; 1879-2472
• DOI: 10.1016/j.thromres.2010.05.011

Abstract Introduction Pelvic deep vein thrombosis (DVT) is difficult to diagnose during pregnancy. In a two-center trial, we evaluated the agreement between ultrasonography and magnetic resonance imaging (MRI) in diagnosing the extent of DVT into the pelvic veins during pregnancy. Materials and methods Pregnant women with proximal DVT were examined both with ultrasound and MRI as part of a study designed for treatment of DVT during pregnancy. Ultrasound was performed using color flow by specialist in vascular ultrasound with Doppler and compression techniques. The MRI sequences consisted of a 2D Time of Flight angiography with arterial flow suppression and maximum intensity projection reconstructions; a 3D, T1-w-prepared gradient echo sequence with fat saturation for thrombus imaging; a steady-state free precession sequence; and a Turbo-Spin-Echo. No contrast agent was used. Proportion of agreement (κ) for detection of DVT in individual veins was measured for different ipsilateral veins and inferior vena cava. Results All 27 patients were imaged with both techniques at an average gestational age of 29 weeks (range 23-39). Three cases (11.5%) of DVT in the pelvic veins were missed on ultrasound but detected by MRI. The upper limit of the DVT was always depicted at a higher (20 cases, 65.4%) or the same level (seven cases, 34.6%) on MRI than on ultrasound. Agreement expressed as κ was 0.33 (95% CI 0.27-0.40) demonstrating only fair agreement. In one woman the thrombus had propagated into the inferior vena cava, shown only on MRI. Conclusion Our study suggests that in pregnant women there is only fair agreement between ultrasound and MRI for determination of extent of DVT into pelvic veins, with MRI showing consistently more detailed depiction of extension. Our results indicate that MRI has an important role as a complementary technique in the diagnosis of DVT during pregnancy.