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Abstract
Background: Chronic cerebrospinal venous insufficiency (CCSVI) was proposed as the causal trigger for developing multiple sclerosis (MS). However, current data are contradictory and a gold standard for venous flow assessment is missing.
Objective: To compare structural magnetic resonance venography (MRV) and dynamic extracranial color-coded duplex sonography (ECCS) in a cohort of patients with MS.
Methods: We enrolled 40 patients (44 ± 10 years). All underwent contrast-enhanced MRV for assessment of internal jugular vein (IJV) and azygos vein (AV) narrowing, graded into 3 groups: 0%–50%, 51%–80%, and >80%. ECCS analysis of blood flow direction, cross-sectional area (CSA), and blood volume flow (BVF) in both IJV and vertebral veins (VV) occurred in the supine and upright body position.
Results: MRV identified 1 AV narrowing. IJV analysis yielded 12 patients for group 1 (30%), 19 patients for group 2 (48%), and 9 patients for group 3 (22%). By ECCS criteria, 4 patients (10%) presented with venous drainage abnormalities. Jugular BVF was different only between groups 1 and 3 (616 ± 133 vs 381 ± 213 mL/min, p = 0.02). No other parameters in supine position and none of the parameters in the upright body position, apart from the IJV-BVF decrease in groups 1 and 3 (479 ± 172 vs 231 ± 144 mL/min, p = 0.01), were different.
Conclusions: Our ECCS data contradict the postulated 100% prevalence of CCSVI criteria in MS. MRV seems more sensitive to detect IJV narrowing compared to ECCS. A measurable hemodynamic effect only exists in vessel narrowings >80%. Our combined data argue against a causal relationship of venous narrowing and MS, favoring the rejection of the CCSVI hypothesis.
Glossary
- GLOSSARY
- AV=
- azygos vein;
- BFV =
- blood flow velocity;
- BVF =
- blood volume flow;
- CBF =
- cerebral blood flow;
- CCSVI =
- chronic cerebrospinal venous insufficiency;
- CSA =
- cross-sectional area;
- ECCS =
- extracranial color-coded duplex sonography;
- EDSS =
- Expanded Disability Status Scale;
- ICA =
- internal carotid artery;
- IJV =
- internal jugular vein;
- IJVVI =
- internal jugular valve incompetence;
- MR =
- magnetic resonance;
- MRV =
- magnetic resonance venography;
- MS =
- multiple sclerosis;
- RRMS =
- relapsing-remitting multiple sclerosis;
- SPMS =
- secondary progressive multiple sclerosis;
- TCCS =
- transcranial color-coded duplex sonography;
- VA =
- vertebral artery;
- VM =
- Valsalva maneuver;
- VV =
- vertebral vein
Footnotes
Study funding: Supported by the German Research Foundation (DFG Exc. 257 to C.P. and F.P.).
- Received May 5, 2011.
- Accepted July 7, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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