ROLE OF 3D/4D DOPPLER ULTRASOUND IN THE EVALUATION OF PELVIC CONGESTION SYNDROME

Abstract

Background: Pelvic Congestion Syndrome (PCS) is a chronic venous condition characterised by dilated and incompetent pelvic veins that commonly produces persistent, non-cyclical pelvic pain in women of reproductive age. Its clinical presentation is non-specific, so the condition is frequently underdiagnosed. Three-dimensional (3D) and four-dimensional (4D) Doppler ultrasound may allow a more detailed assessment of pelvic venous anatomy and hemodynamics than conventional imaging and could improve diagnostic accuracy.

Objective: To evaluate the diagnostic value of 3D/4D Doppler ultrasound in women with chronic pelvic pain suspected of having Pelvic Congestion Syndrome, and to compare its performance with conventional 2D/color Doppler ultrasound.

Methods: This descriptive, cross-sectional study was conducted in the Department of Radiology, Jinnah Hospital, Lahore. Ninety-six women aged 18–45 years with chronic pelvic pain of more than six months’ duration were recruited by non-probability consecutive sampling. All participants underwent both 2D/color Doppler and 3D/4D Doppler ultrasound examination of the pelvic venous system. Venous diameter, reflux, tortuosity and flow velocity were assessed, and the diagnostic yield of the two modalities was compared using the chi-square test and independent t-test, with p < 0.05 considered significant.

Results: The mean age of participants was 30.92 ± 8.05 years. 3D/4D Doppler ultrasound detected significantly more cases of venous reflux than 2D/color Doppler on both the right side (37.5% vs. 29.2%, p = 0.008) and the left side (49.0% vs. 41.7%, p = 0.016). Ovarian vein diameter measured on 3D/4D Doppler was significantly greater than on 2D Doppler on both sides (p < 0.001), and good-to-fair image visualization was achieved in 95.8% of examinations. Venous involvement was more common on the left side, and no clinical or demographic parameter showed a statistically significant independent association with reflux severity.

Conclusion: 3D/4D Doppler ultrasound was superior to conventional 2D/color Doppler ultrasound for the detection of pelvic venous reflux and for delineation of venous anatomy. It is a reliable, non-invasive tool that can support timely diagnosis and clinical management of Pelvic Congestion Syndrome.