Title: Multidetector Computer Tomography in Evaluation of Ovarian Vein Reflux
Authors: Mohamed A A, Mamdouh H H, Chepsiror D K
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.02
Objective:The aim of this study was to determine the role of MDCT in evaluating ovarian vein reflux, identify possible cause and grade its degree. Materials And Methods: Contrast enhanced MDCT images of five hundred and nine (509) female patients scanned between 1st of March 2015 and 31st of August 2015 were reviewed for the evaluation of ovarian veins (normal or pathological states) and any associated abdominal/ pelvic pathology/pathologies. The presence, degree, pathway and associated findings of ovarian vein reflux were evaluated. Results: From the 509 patients, 1006/1018 (98.82%) ovarian veins were identified. There were fifty six (56/509, 11%) female patients who became study subjects with ovarian vein reflux distributed as follows. A total of sixty eight out of 1006 (6.76%) identified ovarian veins had reflux. Right only were 12 OVs, left only, 32 OVs and (12 cases) 24 OVs were bilateral. Majority, 51/68 (75%) of refluxing OVs were of secondary type (identifiable cause) and 17/68 (25%) were of primary type (no identifiable cause). Most of the refluxing OVs (38/68, 55.88%) were of grade II, followed grade I (20/68, 29.41%) while those of grade III were 10 (14.71%). Grade III had statistical significance in its occurrence on the left OVs compared to the right OVs (p=0.011). Conclusion: Both primary and secondary OV reflux exist. Left ovarian vein was the most affected by reflux as well as the severe grade III seen extending to contralateral ovarian vein plexus by passing through the dilated para-uterine and uterine veins with none affecting the right one. In overall, grade II reflux was common on both OVs. 1. Hiromura T, Nishioka T, Nishioka S, Ikeda H, Tomita K. Reflux in the left ovarian vein: analysis of MDCT findings in asymptomatic women. American Jou. of Roentgenology 04;183 (5):1411-5. 2. Ignacio EA, Ruchika Dua I, Sarin S, Harper AS, Yim D, Mathur V, et al., editors. Pelvic congestion syndrome: diagnosis and treatment. Seminars in interventional radiology 2008: Thieme Medical Publishers. 3. Durham JD, Machan L, editors. Pelvic congestion syndrome. Seminars in interventional radiology 2013: Thieme Medical Publishers. 4. Osman MW, Nikolopoulos I, Jayaprakasan K, Raine‐Fenning N. Pelvic congestion syndrome. The Obstetrician & Gynaecologist 2013;15(3):151-7 5. ASCIUTTO G. Pelvic vein incompetence: a review of diagnosis and treatment. History of venous surgery (3) PAGE 59. 2012;19(2):84-90. 6. Kaufman JA, Waltman AC, Rivitz SM, Geller SC. Anatomical observations on the renal veins and inferior vena cava at magnetic resonance angiography. Cardiovascular and interventional radiology 1995;18(3):153-7. 7. Kuligowska E, Deeds III L, Lu III K. Pelvic Pain: Overlooked and Underdiagnosed Gynecologic Conditions. Radiographics 2005;25(1):3-20. 8. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates Obstetrics & Gyn. 1996;87(3):321-7. 9. Beard R, Reginald P, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. BJOG: An International Journal of Obstetrics & Gynaecology 1988;95(2):153-61. 10. Cordts PR, Eclavea A, Buckley PJ, DeMaioribus CA, Cockerill ML, Yeager TD. Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization. Journal of vascular surgery 1998;28(5):862-8. 11. Hobbs J. The pelvic congestion syndrome. British journal of hospital medicine 1990;43(3):200-6. 12. Lechter A, Alvarez A, Lopez G. Pelvic varices and gonadal veins. Phlebology. 1987;2(3):181-8. 13. Giacchetto C, Catizone F, Cotroneo G, Cavallaro V, Cammisuli F, Minutolo V, et al. Radiologic anatomy of the genital venous system in female patients with varicocele. Surgery, gynecology & obstetrics. 1989;169(5):403-7. 14. Coakley FV, Varghese SL, Hricak H. CT and MRI of pelvic varices in women. Journal of computer assisted tomography 1999;23(3):429-34. 15. Desimpelaere J, Seynaeve P, Hagers Y, Appel B, Mortelmans L. Pelvic congestion syndrome: demonstration and diagnosis by helical CT Abdominal imaging 1999;24 (1): 100-2. 16. Eren S. Multi-Detector Row Computed Tomography Findings of Pelvic Congestion Syndrome Caused by Dilated Ovarian Veins The Eurasian Journal of Medicine 2010;42(3):128. 17. Freedman J, Ganeshan A, Crowe P. Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. Postgraduate medical journal 2010;86(1022):704-10. 18. Osman MW, Nikolopoulos I, Jayaprakasan K, Raine‐Fenning N. Pelvic congestion syndrome. The Obstetrician & Gynaecologist 2013;15(3):151-7 19. Asayama Y, Yoshimitsu K, Aibe H, Nishie A, Kakihira D, Irie H, et al. MDCT of the gonadal veins in females with large pelvic masses: value in differentiating ovarian versus uterine origin. Ajr 2006;186 (2):440-8. 20. Rozenblit AM, Ricci ZJ, Tuvia J, Amis Jr ES. Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. American Journal of Roentgenology 2001;176(1):119-22. 21. Ahlberg N, Bartley O, Chidekel N. Right and left gonadal veins an anatomical and statistical study. Acta Radiologica (Sweden) 1966;4(6):593-601.Abstract
References