title: Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy.
abstract: BACKGROUND
  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.
  
  
  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 (kappa) 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 kappa 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden. michael.torkzad@radiol.uu.se
authors.forename: Michael R
authors.initials: MR
authors.lastname: Torkzad
authors.forename: Katarina
authors.initials: K
authors.lastname: Bremme
authors.forename: Margareta
authors.initials: M
authors.lastname: Hellgren
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Eriksson
authors.forename: Anna
authors.initials: A
authors.lastname: Hagman
authors.forename: Trine
authors.initials: T
authors.lastname: Jörgensen
authors.forename: Kent
authors.initials: K
authors.lastname: Lund
authors.forename: Gunnel
authors.initials: G
authors.lastname: Sandgren
authors.forename: Lennart
authors.initials: L
authors.lastname: Blomqvist
authors.forename: Peter
authors.initials: P
authors.lastname: Kälebo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D055815:Young Adult