Venous drainage in multiple sclerosis: A combined MRI and ultrasound study .
Doepp, F. MD; Wurfel, J.T. MD; Pfueller, C.F. MD; Valdueza, J.M. MD; Petersen, D. MD; Paul, F. MD; Schreiber, S.J. MD
77(19):1745-1751, November 8, 2011.
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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: 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
(C) 2011 American Academy of Neurology