Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy
Received 27 January 2010; received in revised form 26 April 2010; accepted 13 May 2010. published online 07 June 2010.
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.
aDepartment of Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden, Department of Oncology, Radiology and Clinical Immunology, Section of Radiology, Uppsala University
bDepartment of Woman and Child Health, Karolinska Institutet, Department of Obstetrics and Gynecology Karolinska University Hospital, Stockholm, Sweden
cInstitute for the Health of Women and Children, The Sahlgrenska Academy, University of Gothenburg and the Department of Antenatal Care, Primary Care Service, South Bohuslän, Sweden
dDepartment of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden, Karolinska University Hospital, Stockholm, Sweden
eInstitute for the Health of Women and Children, The Sahlgrenska Academy, University of Gothenburg, Sweden
fDepartment of Clinical Physiology, Sahlgrenska University Hospital/Östra, University of Gothenburg, Sweden
gDepartment of Diagnostic Radiology, Karolinska University Hospital Solna, Stockholm, Sweden and Karolinska institute, Stockholm, Sweden
hDepartment of Radiology, Sahlgrenska University Hospital/Östra, University of Gothenburg, Sweden
ABSTRACT