Role of Transvaginal Color Doppler Ultrasound in the Diagnosis of Pelvic Congestion Syndrome
Keywords:
Pelvic Congestion Syndrome, Transvaginal Ultrasound, Color Doppler Ultrasonography, Chronic Pelvic Pain, Pelvic Venous InsufficiencyAbstract
Pelvic Congestion Syndrome (PCS) is a known cause of chronic pelvic pain in women, secondary to pelvic venous insufficiency and varicosities. Diagnosis is still not easy and delayed, due to the non-specific clinical picture. Transvaginal color Doppler ultrasound has proven to be a useful, non-invasive imaging technique for the evaluation of pelvic venous abnormalities. In this study, the authors sought to determine the ability of transvaginal color Doppler ultrasound to diagnose Pelvic Congestion Syndrome in women with chronic pelvic pain. The study was carried out as a prospective cross-sectional study at Tikrit Teaching Hospital, Iraq from Sep. 2023 to Sep. 2024. Ninety women with clinical suspicion of PCS aged 35-55 years were included. Comprehensive clinical assessment was done for all the participants followed by transvaginal grayscale and color Doppler ultrasound examination. Ovarian vein diameter, parametrial vein diameter, venous reflux during the Valsalva maneuver, venous flow velocity and pelvic varicosities were sonographic parameters. Data was analysed using SPSS version 26.0 and a p value of < 0.5 was deemed to be statistically significant. The ages of the subjects were ranged between 40 and 46 years; the average age was 44.3 ± 5.6 years. All patients complained of chronic pelvic pain and pelvic heaviness (80.0%), dyspareunia (64.4%), and post-coital pain (54.4%) were common associated symptoms. Sixteen of the women (67.8%) had been diagnosed with Pelvic Congestion Syndrome. The most common sonographic findings were dilated parametrial veins (66.7%), ovarian vein diameter greater than 6 mm (64.4%), venous reflux during the Valsalva maneuver (67.8%), and slow venous flow velocity < 3 cm/s (63.3%). The diagnostic performance of TV-CDU was excellent, with a sensitivity of 91.8%, a specificity of 86.2%, a positive predictive value of 90.2%, a negative predictive value of 88.0%, and an overall diagnostic accuracy of 90.0%. There was significant correlation between ovarian vein diameter, venous reflux duration and pain severity (p<0.001). Transvaginal color Doppler ultrasound is an effective, accurate, and non-invasive imaging modality for diagnosis of Pelvic Congestion Syndrome. Because it is able to analyze the anatomic and hemodynamic aspects of pelvic venous insufficiency, it is a good first-line diagnostic test in women suffering from chronic pelvic pain and allows early diagnosis and adequate clinical management.
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