Assessment of jugular endovascular malformations in chronic cerebrospinal venous insufficiency: colour-Doppler scanning and catheter venography compared with intravascular ultrasound

Abstract

CV was significantly inferior to CD sonography and IVUS in detecting JEM. Differences between IVUS and CD sonography in detecting JEM and in quantifying jugular diameters were not significant. The IJV CSA was underestimated by CD sonography compared with IVUS. CD sonography was proven to be important in the anatomical characterization of CCSVI, providing useful information for correct intravascular treatment.

Chronic cerebrospinal venous insufficiency: current perspectives

“…IVUS has revealed even more lesions than catheter venography, since CCSVI seems to be principally an endoluminal disease. 21,[28][29][30][31] This is probably the reason why investigators who utilized nondiluted contrast found less frequent (55%-70%) pathology in patients with multiple sclerosis. 32,33 Also, it should be remembered that catheter venography is inadequate to demonstrate external compression of the IJVs by aberrant muscles, because radiologic contrast injected into the vein, even under low pressure, can easily reopen a compressed vein.…”

“…In addition, the majority of authors did not verify the results of Doppler sonography against a more reliable diagnostic test, such as catheter angiography 26 or IVUS. 30,31 The researchers assessed the IJVs at different levels, used different definitions of normal and abnormal veins, used different sonographic machines, and the sonographers had very different experience in studying the IJVs (it is obvious that some of them evaluated these veins in a manner similar to that used for examination of the carotid arteries). Some of these studies were blinded, ie, the authors did not know whether they were evaluating a patient with multiple sclerosis or a healthy control, 33 test.…”

Diagnostic accuracy of Doppler sonography and magnetic resonance venography for the assessmentv of impaired outflow from the internal jugular vein in patients with multiple sclerosis

“…A high prevalence of venous abnormalities in MS patients, as has already been demonstrated using catheter venography [8][9][10][14][15][16][17][18], makes the search for a proper non-invasive test for CCSVI difficult. Since venous pathologies can be found in the majority of MS patients, theoretically any diagnostic criterion will reveal a high sensitivity and high Bayesian likelihood ratio.…”

“…In CCSVI patients the most prevalent abnormality is the stenotic, 'over-competent' jugular valve [21]. Using invasive diagnostics (catheter venography) about 90% of MS patients can demonstrate such venous occlusive lesions [9,10,[14][15][16][17][18]. Stenotic valves are usually seen in combination with collapsed middle and/or upper parts of the IJV.…”

“…Unfortunately, published guidelines do not give a clear definition of such pathological intraluminal structures [12,20]. Undoubtedly, this part of sonographic assessment of IJVs needs clarification, and perhaps intravascular ultrasound (IVUS), instead of standard sonography, should be used to distinguish normal from pathological valves [16,29,30].…”