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

Torkzad, Michael R.; Bremme, Katarina; Hellgren, Margareta; Eriksson, Maria J.; Hagman, Anna; Jörgensen, Trine; Lund, Kent; Sandgren, Gunnel; Blomqvist, Lennart; Kälebo, Peter

doi:10.1016/j.thromres.2010.05.011

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Volume 126, Issue 2 , Pages 107-112, August 2010

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

Michael R. Torkzad
- Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden, Department of Oncology, Radiology and Clinical Immunology, Section of Radiology, Uppsala University
- Corresponding author. Tel.: +46 18 6110000.
Katarina Bremme
- Department of Woman and Child Health, Karolinska Institutet, Department of Obstetrics and Gynecology Karolinska University Hospital, Stockholm, Sweden
Margareta Hellgren
- Institute 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
Maria J. Eriksson
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden, Karolinska University Hospital, Stockholm, Sweden
Anna Hagman
- Institute for the Health of Women and Children, The Sahlgrenska Academy, University of Gothenburg, Sweden
Trine Jörgensen
- Department of Woman and Child Health, Karolinska Institutet, Department of Obstetrics and Gynecology Karolinska University Hospital, Stockholm, Sweden
Kent Lund
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden, Karolinska University Hospital, Stockholm, Sweden
Gunnel Sandgren
- Department of Clinical Physiology, Sahlgrenska University Hospital/Östra, University of Gothenburg, Sweden
Lennart Blomqvist
- Department of Diagnostic Radiology, Karolinska University Hospital Solna, Stockholm, Sweden and Karolinska institute, Stockholm, Sweden
Peter Kälebo
- Department of Radiology, Sahlgrenska University Hospital/Östra, University of Gothenburg, Sweden

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.

Keywords: Magnetic resonance imaging (MRI), ultrasonography, venous thrombosis, pregnancy