CT Abdomen and Pelvis When pelvic venous disorders are clinically suspected, contrast-enhanced CT of the abdomen and pelvis may demonstrate engorged periuterine and periovarian veins, venous anatomic variants, and occasional compression of the left renal vein resulting in asymmetric left-sided pelvic varicosities [10,19-22]. However, CT lacks the capacity of US or MR to provide dynamic flow information [18]. CT Pelvis When pelvic venous disorders are clinically suspected, contrast-enhanced CT of the pelvis may demonstrate engorged periuterine and periovarian veins, although their drainage into the renal vein or cava will not be evaluated without CT coverage of the abdomen [10,19-22]. In chronic inflammatory disease, CT may demonstrate pelvic fluid, peritoneal thickening, hydrosalpinx or pyosalpinx, and tubo-ovarian abscess [23]. MRI Pelvis MRI is widely regarded as the problem-solving imaging examination of choice for chronic pelvic pain, particularly when US findings are nondiagnostic or inconclusive [11,15,24]. When MRI is clinically indicated, the use of a gadolinium-based IV contrast agent is preferred. Please see the ACR Manual on Contrast Media for additional information [25]. The diagnostic performance of MRI/MR angiography is comparable to conventional venography for identifying pelvic venous disorders [26,27]. The use of MRI for this indication is growing accordingly [28], necessitating standardized interpretation and reporting [29]. T2-weighted imaging has the capacity to demonstrate pelvic varices, but signal intensity varies with flow velocity. Vein conspicuity and flow directional assessment are superior using time-resolved postcontrast T1-weighted imaging, which can directly demonstrate ovarian vein reflux [10,30]. Noninvasive imaging with MRI has largely supplanted conventional venography for diagnostic purposes, but venography may still be performed in the context of intended intervention.
Postmenopausal Subacute or Chronic Pelvic Pain. CT Abdomen and Pelvis When pelvic venous disorders are clinically suspected, contrast-enhanced CT of the abdomen and pelvis may demonstrate engorged periuterine and periovarian veins, venous anatomic variants, and occasional compression of the left renal vein resulting in asymmetric left-sided pelvic varicosities [10,19-22]. However, CT lacks the capacity of US or MR to provide dynamic flow information [18]. CT Pelvis When pelvic venous disorders are clinically suspected, contrast-enhanced CT of the pelvis may demonstrate engorged periuterine and periovarian veins, although their drainage into the renal vein or cava will not be evaluated without CT coverage of the abdomen [10,19-22]. In chronic inflammatory disease, CT may demonstrate pelvic fluid, peritoneal thickening, hydrosalpinx or pyosalpinx, and tubo-ovarian abscess [23]. MRI Pelvis MRI is widely regarded as the problem-solving imaging examination of choice for chronic pelvic pain, particularly when US findings are nondiagnostic or inconclusive [11,15,24]. When MRI is clinically indicated, the use of a gadolinium-based IV contrast agent is preferred. Please see the ACR Manual on Contrast Media for additional information [25]. The diagnostic performance of MRI/MR angiography is comparable to conventional venography for identifying pelvic venous disorders [26,27]. The use of MRI for this indication is growing accordingly [28], necessitating standardized interpretation and reporting [29]. T2-weighted imaging has the capacity to demonstrate pelvic varices, but signal intensity varies with flow velocity. Vein conspicuity and flow directional assessment are superior using time-resolved postcontrast T1-weighted imaging, which can directly demonstrate ovarian vein reflux [10,30]. Noninvasive imaging with MRI has largely supplanted conventional venography for diagnostic purposes, but venography may still be performed in the context of intended intervention.