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Abstract
Background: Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in patients with multiple sclerosis (MS). A subject is considered CCSVI positive if ≥2 venous hemodynamic (VH) criteria are fulfilled.
Objective: To determine prevalence of CCSVI in a large cohort of patients with MS, clinically isolated syndrome (CIS), other neurologic diseases (OND), and healthy controls (HC), using specific proposed echo-color Doppler (ECD) criteria.
Methods: Transcranial and extracranial ECD were carried out in 499 enrolled subjects (289 MS, 163 HC, 26 OND, 21 CIS). Prevalence rates for CCSVI were calculated in 3 ways: first, using only the subjects for whom diagnosis was certain (i.e., borderline subjects were excluded); secondly, including the borderline subjects in the “no CCSVI” group; and finally, taking into account subjects who presented any of the VH criteria.
Results: CCSVI prevalence with borderline cases included in the “no CCSVI” group was 56.1% in MS, 42.3% in OND, 38.1% in CIS, and 22.7% in HC (p < 0.001). The CCSVI prevalence figures were 62.5% for MS, 45.8% for OND, 42.1% for CIS, and 25.5% for HC when borderline cases were excluded (p < 0.001). The prevalence of one or more positive VH criteria was the highest in MS (81.3%), followed by CIS (76.2%), OND (65.4%), and HC (55.2%) (p < 0.001). CCSVI prevalence was higher in patients with progressive than in nonprogressive MS (p = 0.004).
Conclusions: Our findings are consistent with an increased prevalence of CCSVI in MS but with modest sensitivity/specificity. Our findings point against CCSVI having a primary causative role in the development of MS.
Footnotes
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Study funding: Supported by internal resources of the Buffalo Neuroimaging Analysis Center and Baird MS Center, the Jacobs Neurological Institute, University of Buffalo; the Direct MS Foundation; the Jacquemin Family Foundation; and smaller donors. The results from the CTEVD study led to the organization of the IRB-approved (HSIRB NEU2860310E), unblinded, open-label descriptive study into CCSVI that includes patients with either possible or definite MS. The purpose of this fee-for-service registry study is to enhance utilization of data on venous anomalies that are obtained on individuals who have sought information on CCSVI status.
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Editorial, page 98
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- CCSVI=
- chronic cerebrospinal venous insufficiency;
- CIS=
- clinically isolated syndrome;
- CTEVD=
- Combined Transcranial and Extracranial Venous ECD Evaluation;
- ECD=
- echo-color Doppler;
- EDSS=
- Expanded Disability Status Scale;
- HC=
- healthy control;
- MRV=
- magnetic resonance venography;
- MS=
- multiple sclerosis;
- NMO=
- neuromyelitis optica;
- NPV=
- negative predictive value;
- OND=
- other neurologic disease;
- OR=
- odds ratio;
- PPMS=
- primary progressive multiple sclerosis;
- PPV=
- positive predictive value;
- PRMS=
- progressive-relapsing multiple sclerosis;
- RRMS=
- relapsing-remitting multiple sclerosis;
- SPMS=
- secondary progressive multiple sclerosis;
- VH=
- venous hemodynamic criteria.
- Received July 12, 2010.
- Accepted October 19, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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- Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS
- Reply to Morovic
- Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS
- Reply to Barraccini
- Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS
- Reply To Albayram
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