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Magnetic Resonance Imaging in Proximal Venous Outflow Obstruction
Benjamin B Massenburg1, Harvey N Himel2, Robert C Blue3
1Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Annals of Vascular Surgery
|August 29, 2015
Summary
Magnetic resonance venography (MRV) can effectively rule out proximal venous outflow obstruction (PVOO) with 100% sensitivity. However, its low specificity means MRV cannot confirm PVOO and a better noninvasive test is needed.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Medical Technology
Background:
- Proximal venous outflow obstruction (PVOO) is increasingly linked to lower extremity venous disease.
- Current guidelines lack a noninvasive screening tool for PVOO.
- Magnetic resonance venography (MRV) is frequently used despite no established role.
Purpose of the Study:
- To evaluate the diagnostic value and utility of MRV for screening and diagnosing PVOO.
- To compare MRV findings with intravascular ultrasound (IVUS) and venography.
Main Methods:
- Retrospective analysis of 46 patients with suspected PVOO.
- All patients underwent MRV, followed by IVUS and venography.
- MRV interpretations were blinded and correlated with IVUS/venography results.
Main Results:
- MRV demonstrated 100% sensitivity and 22.7% specificity for PVOO detection.
- The negative predictive value of MRV was 100%, while the positive predictive value was 58.5%.
Conclusions:
- MRV is a reliable tool for excluding PVOO due to its high sensitivity.
- The low specificity and high false positive rate (41.5%) limit MRV's ability to confirm PVOO.
- Further research is needed for a more accurate noninvasive diagnostic test for suspected PVOO.
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