Non-contrast MRI diagnostic protocol for pelvic venous disorders

RATIONALE AND OBJECTIVES: Pelvic venous disorders (PeVD) remain a challenging diagnosis due to their nonspecific clinical presentation and the limitations of current imaging techniques. Conventional imaging of this pathology frequently relies on ultrasound or scans with contrast administration, which may not be sufficient or suitable for all patients. This work aims to present a fast non-contrast magnetic resonance imaging (MRI) protocol optimized for comprehensive assessment of pelvic veins and exclusion of alternative pathologies. MATERIALS AND METHODS: We developed a non-contrast MRI protocol using a 1.5 T scanner platform, with a focus on time-efficient sequences that maximize venous visualization. The protocol includes single-shot gradient echo T2/T1, IR FSE, T2 Motion Reduction, and T1 fat suppression Dixon sequences. The parameters were chosen based on their ability to clearly show large, medium, and small pelvic veins while minimizing motion artifacts and total scanning time. RESULTS: The final protocol achieves fast and comprehensive coverage of the pelvic venous system. The optimized imaging sequences provide high-resolution anatomical detail, enabling a reliable assessment of venous dilatation associated with PeVD, including the ovarian veins, internal iliac vein branches, pelvic leaks, and the inferior vena cava. Simultaneously, the protocol facilitates the exclusion of alternative pelvic pathologies, such as endometriosis, that could present with overlapping symptoms. CONCLUSION: We propose a non-contrast, time-efficient MRI protocol optimized for evaluating PeVD. By improving the detection and characterization of venous abnormalities without the need for contrast enhancement, this protocol may contribute to improved patient safety by limiting contrast media usage, decreasing examination time, and facilitating the appropriate clinical management of chronic pelvic pain.