{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:33:15Z","timestamp":1789990395771,"version":"4.0.1"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Pelvic congestion syndrome (PCS) is a prevalent but underdiagnosed cause of chronic pelvic pain. Venography remains the diagnostic reference, yet its invasiveness limits routine use. This study evaluated standardized duplex ultrasound and developed a scoring system to guide selective, evidence\u2010based venographic referral.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective diagnostic\u2010accuracy study, 60 women with chronic pelvic pain underwent standardized transabdominal and transvaginal duplex ultrasound, and 40 subsequently underwent selective venography as the reference standard. Ultrasound parameters included venous diameter, evoked caudal flow duration, flow direction, velocity, bilaterality, and myometrial plexus enlargement. Penalized logistic regression with bootstrap\u2010nested cross\u2010validation identified independent predictors of venography\u2010confirmed PCS. Coefficients were converted into a point\u2010score to classify patients into rule\u2010out, indeterminate, and rule\u2010in bands. Diagnostic performance, calibration, and decision\u2010curve analyses were used to evaluate discrimination and clinical utility across probability thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Venography confirmed PCS in 26 of 40 participants (65%). A 6\u2010mm diameter threshold provided optimal diagnostic balance (sensitivity 92.3%, specificity 64.3%). The penalized model retained diameter, reflux \u22651.0\u2009second, low velocity \u22643\u2009cm\/second, Valsalva\u2010evoked caudal flow, myometrial plexus enlargement, and bilaterality, achieving an optimism\u2010corrected AUC of 0.861. The derived score stratified patients into rule\u2010out, indeterminate, and rule\u2010in groups with high predictive accuracy (positive predictive value 93.3%, negative predictive value 91.7%). Decision\u2010curve analysis showed higher net benefit than treat\u2010all or treat\u2010none strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Standardized duplex ultrasound integrating morphologic and hemodynamic parameters accurately identified venographic PCS and enabled selective triage. The validated score supports ultrasound as an effective, noninvasive first\u2010line tool to optimize venography and guide patient\u2010centered management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jum.70199","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T04:15:28Z","timestamp":1771560928000},"page":"1545-1556","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Optimizing Venographic Referrals in Pelvic Congestion Syndrome"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9011-0841","authenticated-orcid":false,"given":"Mohammad Masih","family":"Mansouri\u2010Tehrani","sequence":"first","affiliation":[{"name":"Department of Radiology, School of Medicine Iran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6563-7035","authenticated-orcid":false,"given":"Razieh","family":"Shahnazari","sequence":"additional","affiliation":[{"name":"Firoozabadi Clinical Research Development Unit (FACRDU), Department of Radiology, School of Medicine Iran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1118-2749","authenticated-orcid":false,"given":"Hamed","family":"Iraji","sequence":"additional","affiliation":[{"name":"Firoozgar Clinical Research Development Center (FCRDC), Department of Radiology, School of Medicine Iran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2987-2254","authenticated-orcid":false,"given":"Mohammad Mersad","family":"Mansouri Tehrani","sequence":"additional","affiliation":[{"name":"Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam\u2010Khomeini Hospital Complex Tehran University of Medical Science  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8475-5045","authenticated-orcid":false,"given":"Moein","family":"Ghasemi","sequence":"additional","affiliation":[{"name":"School of Medicine Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"StatPearls","author":"Kuo 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