Extracranial venous hemodynamics in multiple sclerosis
A case-control study
Abstract
Objectives:
A chronic state of impaired cerebral and cervical venous drainage, termed chronic cerebrospinal venous insufficiency (CCSVI), has recently been implicated in the pathogenesis of multiple sclerosis (MS). We performed a color-coded Doppler sonography case-control study to externally validate the CCSVI criteria.
Methods:
We prospectively evaluated consecutive patients with clinically definite MS and healthy volunteers using extracranial and transcranial color-coded Doppler sonography. The recently developed neurosonology criteria for CCSVI detection were used for interpretation of ultrasound assessments. The presence of venous reflux in cervical veins was assessed both in the sitting and upright position during a short period of apnea and after Valsalva maneuver.
Results:
We recruited 42 patients with MS (mean age 39 ± 11 years, 17 men) and 43 control individuals (mean age 38 ± 12 years, 16 men). Very good/excellent intrarater and interrater agreement (κ values 0.82–1.00) was documented in 3 out of 5 CCSVI criteria. There was no evidence of stenosis or nondetectable Doppler flow in cervical veins in patients and controls. Reflux in internal jugular vein (IJV) was documented in 1 patient (2%) and 1 control subject (2%), both in sitting and supine posture during apnea. After performing Valsalva maneuver, we documented the presence of IJV valve incompetence in 3 patients with MS (7%) and 4 healthy volunteers (9%; p > 0.999).
Conclusions:
With established reproducibility of venous ultrasound testing, our data argue against CCSVI as the underlying mechanism of MS. Without further independent validation of CCSVI, potentially dangerous endovascular procedures, proposed as novel therapy for MS, should not be performed outside controlled clinical trials.
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Copyright © 2011 by AAN Enterprises, Inc.
Publication History
Received: January 17, 2011
Accepted: March 10, 2011
Published online: August 17, 2011
Published in print: September 27, 2011
Authors
Author Contributions
Dr. Tsivgoulis: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, study supervision. Dr. Mantatzis: drafting/revising the manuscript, contribution of vital reagents/tools/patients. Dr. Bogiatzi: analysis or interpretation of data, acquisition of data. Dr. Vadikolias: drafting/revising the manuscript, study concept or design. Dr. Voumvourakis: drafting/revising the manuscript, acquisition of data. Dr. Prassopoulos: drafting/revising the manuscript. Dr. Piperidou: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data, statistical analysis. Dr. Heliopoulos: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data, statistical analysis.
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Cited By
- No association between variations in extracranial venous anatomy and clinical outcomes in multiple sclerosis patients over 5 years, BMC Neurology, 19, 1, (2019).https://doi.org/10.1186/s12883-019-1350-2
- Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in people with multiple sclerosis, Cochrane Database of Systematic Reviews, 2019, 7, (2019).https://doi.org/10.1002/14651858.CD009903.pub3
- Four-dimensional flow magnetic resonance imaging and ultrasound assessment of cerebrospinal venous flow in multiple sclerosis patients and controls, Journal of Cerebral Blood Flow & Metabolism, 37, 4, (1483-1493), (2016).https://doi.org/10.1177/0271678X16657345
- The effect of body position on developing ultrasound criteria for the assessment of the internal jugular vein, Ultrasound, 23, 2, (85-89), (2015).https://doi.org/10.1177/1742271X15576272
- Brain Hyperechogenicities are not Associated with Venous Insufficiency in Multiple Sclerosis: A Pilot Neurosonology Study, Journal of Neuroimaging, 26, 1, (150-155), (2015).https://doi.org/10.1111/jon.12248
- Evaluation of Hemodynamic Properties of Cerebral Venous Drainage in Patients with Multiple Sclerosis: A Case-Control Study, Polish Journal of Radiology, 79, (323-327), (2014).https://doi.org/10.12659/PJR.890690
- Prospective randomized trial of venous angioplasty in MS (PREMiSe), Neurology, 83, 5, (441-449), (2014)./doi/10.1212/WNL.0000000000000638
- Cerebrospinal Venous Outflow in Multiple Sclerosis Patients versus Fatigue and/or Depression, Interventional Neurology, 2, 4, (193-200), (2014).https://doi.org/10.1159/000363070
- Recommendations for Multimodal Noninvasive and Invasive Screening for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal Venous Insufficiency: A Position Statement of the International Society for Neurovascular Disease, Journal of Vascular and Interventional Radiology, 25, 11, (1785-1794.e17), (2014).https://doi.org/10.1016/j.jvir.2014.07.024
- Prevalence of extracranial venous narrowing on catheter venography in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study, The Lancet, 383, 9912, (138-145), (2014).https://doi.org/10.1016/S0140-6736(13)61747-X
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