Can MRI detect vein compression causing leg nerve pain?

Question

Hello doctor,

I have nerve pain and compression down my left leg following gonadal vein embolization with copper coils. My X-ray shows a pronounced hook on one end, and the other side appears too long. My MRI confirms something else is present, and my spine doctors have ruled out my subpar discs.

My question is:

Do my altered veins need to be traced downward to look for a constriction, or can this be determined from my existing MRIs and CT scans?
Does it require evaluation by an interventional radiologist from the inside?

I hope not, as they are difficult to access. I am losing my mobility and my ability to enjoy daily activities, and I am not getting younger at 67, especially if this might be a simple fix.

I have already had an MRI and two CT scans, and I think this might even be assessed with an ultrasound.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Based on your history, the most likely cause of your symptoms is post-embolization-related nerve irritation or venous congestion rather than a primary spine problem, especially since spine specialists have already ruled out significant disc pathology.

After gonadal vein embolization with coils, a few mechanisms can explain your leg pain:

The first mechanism is mechanical irritation, in which a coil loop or its position can occasionally irritate adjacent structures.
Pelvic venous congestion or altered venous drainage can lead to atypical nerve-type pain radiating to the leg.
There can be collateral vein formation or residual reflux. Sometimes symptoms persist if all abnormal veins are not fully addressed.

Regarding your main question, no, veins do not always need to be traced downward invasively as a first step.

The next step is the practical approach. CTV (computed tomography venography) or MRV (magnetic resonance venography), which we review specifically for pelvic veins and coil position, can assess the following:

Coil placement.
Any migration or abnormal projection.
Residual or collateral venous channels.

Targeted Doppler ultrasound (pelvic and proximal leg veins), which can be helpful but is operator-dependent.

The invasive testing is needed; if non-invasive imaging is inconclusive and symptoms are severe or progressive, then diagnostic venography by an interventional radiologist may be required. This can also allow simultaneous treatment if a correctable issue is found.

Important red flags in your case are progressive loss of mobility and persistent unilateral nerve-type pain.

These justify reevaluation by an interventional radiologist rather than only spine specialists.

Your symptoms can be related to the embolization. Noninvasive imaging review (MRV or CTV) should be done first. If needed, venography can both diagnose and potentially fix the issue.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.