RT Journal Article
SR Electronic
T1 Venous drainage in multiple sclerosis
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1745
OP 1751
DO 10.1212/WNL.0b013e318236f0ea
VO 77
IS 19
A1 Doepp, F.
A1 Würfel, J.T.
A1 Pfueller, C.F.
A1 Valdueza, J.M.
A1 Petersen, D.
A1 Paul, F.
A1 Schreiber, S.J.
YR 2011
UL http://n.neurology.org/content/77/19/1745.abstract
AB 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. GLOSSARYAV=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