Venous drainage in multiple sclerosis: A combined MRI and ultrasound study

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Item Type:	Article
Title:	Venous drainage in multiple sclerosis: A combined MRI and ultrasound study
Creators Name:	Doepp, F., Wuerfel, J.T., Pfueller, C.F., Valdueza, J.M., Petersen, D., Paul, F. and Schreiber, S.J.
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.
Keywords:	Cross-Sectional Studies, Jugular Veins, Magnetic Resonance Imaging, Multiple Sclerosis, Phlebography, Pilot Projects, Color Doppler Ultrasonography, Venous Insufficiency
Source:	Neurology
ISSN:	0028-3878
Publisher:	Lippincott Williams & Wilkins
Volume:	77
Number:	19
Page Range:	1745-1751
Date:	8 November 2011
Official Publication:	https://doi.org/10.1212/WNL.0b013e318236f0ea
PubMed:	View item in PubMed

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