Pelvic venous disorders (PeVD): objective hemodynamic signature from quantitative 2-dimensional phase-contrast...

The lack of objective hemodynamic criteria for diagnosing pelvic venous disorders (PeVD) limits interdisciplinary consensus in vascular surgery, radiology, phlebology and gynecology societies. We applied non-contrast 2D phase-contrast MRI (2D PC-MRI, QFlow) to quantify pelvic-lower-limb venous flow and assess diagnostic performance.

A retrospective cross-sectional study was conducted on 428 women who underwent 2D PC-MRI between 2017 and 2024. Participants included PeVD (n=138), healthy controls (HC; n=39), and symptomatic non-PeVD patients (Non-PeVD; n=251). An additional subset of symptomatic PeVD who underwent venous intervention (n=26) was analyzed. Hemodynamic parameters included stroke volume (SV), mean flux (MF) , stroke distance (SD), mean velocity (MV), and ankle interstitial pixel-shift signals.

PeVD patients demonstrated a consistent hemodynamic signature marked by increased central flow, reduced superficial flow, and left gonadal vein (LGV) reflux. Compared with HC, PeVD showed higher right EIV SV and MF, lower left GSV SV and MF, and pronounced LGV abnormalities (SV 1.29 vs 0.54 mL; MF 1.50 vs 0.60 cm³/s; SD -0.50 vs 2.14; MV -0.49 vs 2.39; all p=0.0001). Popliteal vein flow was altered, and ankle signals were elevated. ROC analysis identified left GSV hypoflow (AUC 0.69-0.71) and LGV SD/MV (AUC ∼0.70-0.71) as the most informative markers.

Non-contrast 2D PC-MRI yields objective morphology and segment-specific hemodynamics in lower body venous system. LGV reflux and GSV hypoflow are the most informative markers of PeVD.