Abstract Body: Background: There is controversy in the literature regarding the role of pelvic venous abnormalities screening through Magnetic Resonance Venogram (MRV) in patients with Embolic Stroke of Undetermined Source (ESUS) and a Patent Foramen Ovale (PFO). Pelvic DVT is thought to occur uncommonly, however studies have shown that around 20% of patients can have isolated pelvic vein DVTs without evidence of lower extremity DVTs. We aimed to describe diagnostic yield of pelvic MRV in ESUS patients.
Review summary: A systemic search was carried out using PubMed following PRISMA guidelines. We retrieved 6 cross sectional and cohort studies, 2 case series, as well as 9 case reports with a total of 1319 patients and a mean age of 51 years. The diagnostic yield of Pelvic MRV in all included ESUS patients was 10% (95% CI: 8-12). In ESUS patients with a negative lower extremity DVT, the diagnostic yield was 9% (95% CI: 7-10). Patients with ESUS and PFO had significantly higher prevalence of abnormal pelvic MRV findings, OR=3.63 (95% CI: 1.53-8.61, P <0.01). All reviewed studies utilized pelvic MRV, except two reports, which used pelvic CTV.
Conclusion: Pelvic venous abnormalities are relatively common findings in ESUS patients with a PFO and negative lower extremity DVT. Pelvic MRV should be highly considered in these situations as finding pelvic vein DVT would change the management in these patients as they will need anticoagulation. Future research should strive to provide clear guidance on clinical decision making and cost effectiveness of utilizing this valuable tool using highly controlled, comparative studies.