Dataset Information

Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review.

ABSTRACT:

Introduction

In the work-up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non-invasive diagnostic tools are found to be accurate, invasive venography might no longer be indicated as necessary.

Material and methods

A literature search in Pubmed and EMBASE was performed from inception until 6 May 2017. Studies comparing non-invasive diagnostic tools to a reference standard in the work-up of patients with (suspected) pelvic congestion syndrome were included. Relevant data were extracted and methodological quality of individual included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Results

Nine studies matched our inclusion criteria. Six studies compared ultrasonography to venography and three studies described a magnetic resonance imaging technique. In using transvaginal ultrasonography, the occurrence of a vein greater than five mm crossing the uterine body had a specificity of 91% (95% CI; 77-98%) and occurrence of pelvic varicoceles a sensitivity and specificity of 100% (95% CI; 89-100%) and 83-100% (95% CI; 66-93%), respectively. In transabdominal ultrasonography, reversed caudal flow in the ovarian vein accounted for a sensitivity of 100% (95% CI; 84-100%). Detection of pelvic congestion syndrome with magnetic resonance imaging techniques resulted in a sensitivity varying from 88 to 100%.

Conclusions

The sensitivity of ultrasonography and magnetic resonance imaging seem to be adequate, which indicates a role for both tests in an early stage of the diagnostic workup. However, due to methodological flaws and diversity in outcome parameters, more high standard research is necessary to establish a clear advice for clinical practice.

SUBMITTER: Steenbeek MP

PROVIDER: S-EPMC6033028 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review.

Steenbeek Miranda P MP van der Vleuten Carine J M CJM Schultze Kool Leo J LJ Nieboer Theodoor E TE

Acta obstetricia et gynecologica Scandinavica 20180223 7

<h4>Introduction</h4>In the work-up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non-invasive diagnostic tools are found to be accurate, invasive venography might no longer be indicated as necessary.<h4>Material and methods</h4>A literature search in Pubmed and EMBASE was performed from inception until 6 May 2017. Studies comparing non-invasive diagnostic tools to a reference standard in the work-up of patients with (suspected) pelvic c ...[more]

PMID: 29381188

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Project description:BackgroundComputerized migraine diagnostic tools have been developed and validated since 1960. We conducted a systematic review to summarize and critically appraise the quality of all published studies involving computerized migraine diagnostic tools.MethodsWe performed a systematic literature search using PubMed, Web of Science, Scopus, snowballing, and citation searching. Cutoff date for search was 1 June 2021. Published articles in English that evaluated a computerized/automated migraine diagnostic tool were included. The following summarized each study: publication year, digital tool name, development basis, sample size, sensitivity, specificity, reference diagnosis, strength, and limitations. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was applied to evaluate the quality of included studies in terms of risk of bias and concern of applicability.ResultsA total of 41 studies (median sample size: 288 participants, median age = 43 years; 77% women) were included. Most (60%) tools were developed based on International Classification of Headache Disorders criteria, half were self-administered, and 82% were evaluated using face-to-face interviews as reference diagnosis. Some of the automated algorithms and machine learning programs involved case-based reasoning, deep learning, classifier ensemble, ant-colony, artificial immune, random forest, white and black box combinations, and hybrid fuzzy expert systems. The median diagnostic accuracy was concordance = 89% [interquartile range (IQR) = 76-93%; range = 45-100%], sensitivity = 87% (IQR = 80-95%; range = 14-100%), and specificity = 90% (IQR = 77-96%; range = 65-100%). Lack of random patient sampling was observed in 95% of studies. Case-control designs were avoided in all studies. Most (76%) reference tests exhibited low risk of bias and low concern of applicability. Patient flow and timing showed low risk of bias in 83%.ConclusionDifferent computerized and automated migraine diagnostic tools are available with varying accuracies. Random patient sampling, head-to-head comparison among tools, and generalizability to other headache diagnoses may improve their utility.

Project description:Purpose: To evaluate medium-term clinical outcomes of transcatheter embolization and stenting in women with several pelvic venous disorders responsible for chronic pelvic pain and varicose veins of the lower limbs. Materials and Methods: The study population included 327 consecutively recruited patients referred to the interventional radiology unit from January 2014 to December 2019 due to chronic pelvic congestion (91; 27.83%), lower limb varices (15; 4.59%), or a combination of both the symptoms (221; 67.58%). Preprocedural pelvic, transvaginal Doppler ultrasound (US), and MRI were conducted in all the patients and revealed anatomical varicosities and incompetent pelvic veins in 312 patients. In all the patients, selective catheterization demonstrated uterine venous engorgement, ovarian plexus congestion, or pelvic vein filling. Retrograde flow was detected on catheter venography in the left ovarian vein (250; 78%), the right ovarian vein (85; 26%), the left internal iliac vein (222; 68%), and the right internal iliac vein (185; 57%). Patients were followed-up at 1, 6, and 12 months, and years thereafter systematically by the referring angiologist and the interventional radiologist of center. They were contacted by telephone in November and December 2020 to assess pain perception and quality of life by using the visual analog scales from 0 to 10 with assessments made at the baseline and last follow-up. Of the 327 patients (mean age, 42 ± 12 years), 312 patients were suffering from pelvic congestion syndrome and 236 patients was suffering from lower limb varices. All underwent embolization by using ethylene vinyl alcohol copolymer (Onyx®). Eighty-five right ovarian veins, 249 left ovarian veins, 510 tributaries of the right internal iliac vein, and 624 tributaries of the left internal iliac vein were embolized. A cohort of patients also underwent nutcracker syndrome angioplasty (6.7%) and May-Thurner syndrome angioplasty (14%) with a stent placement. Results: The initial technical success rate was 80.9% for embolization of pathological veins and 100% for stenting of stenoses. Overall, 307 patients attended 12-month follow-up visits and 288 (82%) patients completed the telephone survey at mean 39 (±18)-month postintervention. Main pelvic pain significantly improved from 6.9 (±2.4) pre- to 2.0 (±2.4) postembolization (p < 0.001), as did specific symptoms in each category. Improvement or disappearance of pain was achieved in 266/288 (92.36%) patients with improved quality of life in 276/288 (95.8%) patients. There were 16 minor and 4 major adverse events reported on the follow-up. Conclusion: Pelvic vein embolization (Onyx®) is an effective and safe procedure with high clinical success and quality of life improvement rates.

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Dataset Information

Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review.

Introduction

Material and methods

Results

Conclusions

Publications

Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review.

Similar Datasets

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