A feasibility study of multi-contrast venography with non-enhanced magnetic resonance techniques in diagnosing iliac vein compression syndrome

Abstract

Objective

To explore the value of multi-contrast venography with non-enhanced magnetic resonance techniques in diagnosing iliac vein compression syndrome (IVCS).

Methods

Eighty-seven patients suspected of IVCS were enrolled and underwent T1-weighted sampling perfection with application-optimized contrasts using different flip angle evolutions (T1 SPACE) and SPACE FLOW magnetic resonance venography (MRV) scans within 2 days of lower extremity computed tomography venography (CTV). The image qualities of CTV, T1 SPACE and SPACE FLOW were evaluated using a 4-point visual scoring system. Vessel diameters and stenosis rates were compared and pelvic collateral vessels were assessed on CTV and MRV images. With the results of digital subtraction angiography (DSA) as the gold standard, receiver operating characteristic (ROC) analysis was used to calculate diagnostic performances of the stenosis rate combined with collateral vessels both CTV and non-enhanced MRV.

Results

Inter-observer agreement on image quality scores was good, with Kappa values of 0.633, 0.756 and 0.769 for CTV, T1 SPACE and SPACE FLOW, respectively. SPACE FLOW and CTV showed comparable image quality, while T1 SPACE had relatively lower quality scores. The stenosis rates measured by T1 SPACE and SPACE FLOW were consistent with CTV results. For the diagnosis of IVCS using stenosis rates and collateral vessels, CTV and MRV showed similar ROC curve areas, with sensitivity/specificity/accuracy of 82.1%/95%/85.1% and 80.6%/95%/83.9%, respectively.

Conclusion

Multi-contrast MRV with non-enhanced techniques can offer complementary information, clearly depict the degree of iliac vein compression and collateral vessels. It can serve as another auxiliary examination method for clinical diagnosis of IVCS.