The standard initial noninvasive imaging modality for diagnosing May-Thurner syndrome is duplex ultrasound, but this modality provides only indirect measures and is frequently limited, necessitating further imaging to make the diagnosis. Other noninvasive imaging modalities (computed tomographic venography, time of flight, magnetic resonance venography) allow for direct visualization but lack hemodynamic and anatomic information about what is occurring throughout the cardiac cycle. Intravascular ultrasound is the invasive tool of choice in the setting of iliac vein compression syndrome, but quality, noninvasive imaging modalities have yet to be described. Contrast-enhanced, dynamic magnetic resonance venography allows for detailed imaging of the pelvis as well as dynamic vascular imaging, improving preoperative planning.
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