Combined high-resolution 3D CUBE T1-weighted imaging and non-contrast-enhanced magnetic resonance venography for evaluation of vein stenosis in May–Thurner syndrome
Restricted accessResearch articleFirst published online February, 2022
Combined high-resolution 3D CUBE T1-weighted imaging and non-contrast-enhanced magnetic resonance venography for evaluation of vein stenosis in May–Thurner syndrome
To explore the feasibility of high-resolution MRI 3-dimensional (3D) CUBE T1-weighted magnetic resonance imaging (MRI) in combination with non-contrast-enhanced (NCE) magnetic resonance venography (MRV) for the assessment of lumen stenosis in May–Thurner syndrome.
Methods
Twenty-nine patients underwent computed tomography venography (CTV) and high-resolution MRI-CUBE T1, and NCE MRV acquisitions. ANOVA and LSD tests were used to compare the stenosis rate and narrowest and distal diameters of the vessel lumen.
Results
There were no significant differences in the estimated stenosis rate between CTV, CUBE T1, and NCE MRV (p = 0.768). However, there were significant differences in the measured stenosis diameters of the left common iliac vein (LCIV), with CTV giving the largest mean diameter and CUBE had the smallest mean diameter (p < 0.05). The measured normal LCIV diameters did not significantly differ between MRV and CUBE (p = 0.075) but were significantly larger on CTV than on MRV and CUBE (p < 0.05).
Conclusions
Compared with CTV, a combination of CUBE and MRV could provide an improved assessment of the degree of lumen stenosis in May–Thurner syndrome and demonstrate acute thrombosis. MRI underestimates the diameter of the vessel in comparison with CTV. MRI can be a substitute tool for Duplex ultrasound and CTV.
GurelKGurelSKaravasE, et al. Direct contrast-enhanced MR venography in the diagnosis of May-Thurner syndrome. Eur J Radiol2011; 80: 533–536.
2.
MayRThurnerJ.The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology1957; 8: 419–427.
3.
CockettFBThomasMLNegusD.Iliac vein compression – its relation to iliofemoral thrombosis and the post-thrombotic syndrome. Br Med J1967; 2: 14–19.
4.
HellerTTeichertCHaferJ, et al. Prevalence of May-Thurner syndrome in patients with deep vein thrombosis at a large medical referral center. Rofo2019; 191: 1107–1117.
5.
KibbeMRUjikiMGoodwinAL, et al. Iliac vein compression in an asymptomatic patient population. J Vasc Surg2004; 39: 937–943.
6.
BondarevSKellerEJHanT, et al. Predictors of disease recurrence after venoplasty and stent placement for May–Thurner syndrome. J Vasc Interv Radiol2019; 30: 1549–1554.
NeglenPHollisKCOlivierJ, et al. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg2007; 46: 979–990.
9.
BozkayaHCinarCErtugayS, et al. Endovascular treatment of iliac vein compression (May-Thurner) syndrome: angioplasty and stenting with or without manual aspiration thrombectomy and catheter-directed thrombolysis. Ann Vasc Dis2015; 8: 21–28.
10.
BeliardSFeuvrierDDucrouxE, et al. May thurner syndrome revealed by left calf venous claudication during running, a case report. BMC Sports Sci Med Rehabil2018; 10: 3.
11.
HngJZKSuSAtkinsonN.May-Thurner syndrome, a diagnosis to consider in young males with no risk factors: a case report and review of the literature. J Med Case Rep2021; 15: 141.
12.
HarbinMMLutseyPL.May-Thurner syndrome: history of understanding and need for defining population prevalence. J Thromb Haemost2020; 18: 534–542.
13.
BrinegarKNShethRAKhademhosseiniA, et al. Iliac vein compression syndrome: clinical, imaging and pathologic findings. World J Radiol2015; 7: 375–381.
14.
WolpertLMRahmaniOSteinB, et al. Magnetic resonance venography in the diagnosis and management of May-Thurner syndrome. Vasc Endovascular Surg2002; 36: 51–57.
15.
HsuY-CHuangY-KHsuL-S, et al. Using non-contrast-enhanced magnetic resonance venography for the evaluation of May-Thurner syndrome in patients with renal insufficiency. Medicine (Baltimore)2019; 98: e18427.
16.
Li RlYGChenHWHuangY, et al. Value of MRI classification for interventional thrombolytic efficacy in DVT. Chin J CT MRI2013; 11: 102–120.
17.
Hb. XuXKYangYLXiaoXH, et al. Evaluation of CE MRA, MCA and 2D TOF MRA for peripheral vascular disease: an in vitro experiment and clinical application. J Clin Radiol2001; 20: 392–397.
18.
RuehmSGWiesnerWDebatinJF.Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience. Radiology2000; 215: 421–427.
19.
RuehmSGZimnyKDebatinJF.Direct contrast-enhanced 3D MR venography. Eur Radiol2001; 11: 102–112.
20.
DouglasGWFraserMMoodyARFrcrFIRDMartelAL, et al. Deep venous thrombosis: diagnosis by using venous enhanced subtracted peak arterial MR venography versus conventional venography. Radiology2003; 226: 812–820.
21.
McdermottSOliveiraGErgulE, et al. May-Thurner syndrome: can it be diagnosed by a single MR venography study?Diagn Interv Radiol2012; 19: 44–48.
22.
HagleyDSahaPBlackS.Optimal diagnostics of residual stenosis after lysis. Phlebology2016; 31: 11–14.
23.
JayarajARajuS.Three-dimensional computed tomography venogram enables accurate diagnosis and treatment of patients presenting with symptomatic chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord2021; 9: 73–80.
24.
KovačAJanićMNurediniD, et al. The influence of May-Thurner syndrome on post-thrombotic syndrome in young women. Vasa2019; 48: 393–398.
25.
DeStephanoCCWernerEFHollyBP, et al. Diagnosis and management of iliac vein thrombosis in pregnancy resulting from May-Thurner syndrome. J Perinatol2014; 34: 566–568.
26.
AkramFSadashivRG.May-Thurner syndrome: an overlooked cause of venous thromboembolism. Med J Aust2020; 212: 402–403. e1.
27.
MengYQinHMaQ, et al. Deep vein thrombosis due to May-Thurner syndrome: a case report. BMC Cardiovasc Disord2020; 20: 233.
28.
YongETanGWLHuangIKH, et al. Pressed for time: implications of a delayed presentation of venous thromboembolism precipitated by COVID-19 and May-Thurner syndrome. Br J Surg2020; 107: e550–e551.
29.
BreddinH.Thrombosis and Virchow's triad: what is established?Semin Thromb Hemost1989; 15: 237–239.
30.
RohrAMaxwellKBestS, et al. Rare presentation and endovascular treatment of multifocal iliac venous stenoses due to right sided May-Thurner syndrome. Radiol Case Rep2020; 15: 201–203.
31.
HoAMHChungADMizubutiGB.A hairdresser's painful swollen left leg: artery compresses vein in May–Thurner syndrome. The Lancet2019; 394: e33.
32.
TrincheroASchottenSLammleB, et al. May-Thurner syndrome: missed diagnosis and missed early treatment?Hamostaseologie2017; 37: 184–185.
33.
LiM-LXuY-YHouB, et al. High-resolution intracranial vessel wall imaging using 3D CUBE T1 weighted sequence. Eur J Radiol2016; 85: 803–807.
34.
LiangJGuoJLiuD, et al. Application of high-resolution CUBE sequence in exploring stroke mechanisms of atherosclerotic stenosis of middle cerebral artery. J Stroke Cerebrovasc Dis2019; 28: 156–162.
MeiJYDeshmukhUNegiM, et al. May-Thurner syndrome in pregnancy: a multi-institutional case series and review of the literature. Am J Obstet Gynecol MFM2020; 2: 100240.
37.
AvilaLCullinanNWhiteM.Pediatric May-Thurner syndrome – systematic review and individual patient data meta-analysis. J Thromb Haemost2021; 19: 1283–1293.
38.
SebastianTSpirkDEngelbergerRP, et al. Incidence of stent thrombosis after endovascular treatment of iliofemoral or caval veins in patients with the postthrombotic syndrome. Thromb Haemost2019; 119: 2064–2073.
39.
FraserDGMoodyARMorganPS, et al. Iliac compression syndrome and recanalization of femoropopliteal and iliac venous thrombosis: a prospective study with magnetic resonance venography. J Vasc Surg2004; 40: 612–619.
40.
CerviADouketisJD.Stent thrombosis after endovascular treatment of iliofemoral or caval veins in patients with postthrombotic syndrome. Thromb Haemost2019; 119: 1897–1899.
