Diagnostic Yield of Pelvic MRV in Patients With Embolic Stroke of Undetermined Source (ESUS): A Scoping Review and Metanalysis.

Background: There is a 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 Patent Foramen Ovale (PFO). We aimed to describe diagnostic yield of pelvic MRV in ESUS patients.

Review Summary: A systematic search was carried out using PubMed, ScienceDirect, and Google Scholar on the 5th of January of 2024, following PRISMA guidelines. We retrieved 6 cross-sectional and cohort studies, 2 case series, as well as 12 case reports with a total of 1321 patients and a mean age of 51 years. Only cross-sectional and cohort studies were included in the qualitative synthesis. 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 4 reports, which used pelvic CTV and MRA.

Conclusion: Pelvic venous abnormalities are relatively common findings in ESUS patients with a PFO and negative lower extremity DVT. Pelvic MRV can be considered in these situations. Future research should strive to provide clear guidance on clinical decision-making and cost-effectiveness of utilizing this valuable tool using randomized, controlled, and comparative studies.