Brain Hemodynamic Changes Associated with Chronic Cerebrospinal Venous Insufficiency Are Not Specific to Multiple Sclerosis and Do Not Increase Its Severity

Abstract

Purpose:To investigate the relationship between chronic cerebrospinal venous insufficiency (CCSVI) and cerebral hemodynamic parameters and to disclose any possible involvement in the pathophysiology of multiple sclerosis (MS). Materials and Methods:The study was approved by the institutional review board, and written informed consent was obtained from all participants. The diagnosis of CCSVI was assigned by using specific color Doppler ultrasonographic criteria. Cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time were assessed with dynamic susceptibility contrast material-enhanced magnetic resonance imaging in normal-appearing white matter (NAWM) in 39 patients with MS. Of these, 25 had CCSVI and 14 did not. Twenty-six healthy control subjects were also evaluated, and of these, 14 had CCSVI and 12 did not. Twoway analysis of variance testing was used for statistical analysis, with Bonferroni correction for multiple comparisons. Correlation analysis was performed by calculating Spearman coefficients. Results:Individuals with CCSVI showed cerebral hemodynamic anomalies, such as decreased CBF and CBV, as compared with individuals without CCSVI, without any delay in mean transit time. No significant interaction between MS and CCSVI was found for any hemodynamic parameters. Furthermore, no correlations were found between CBV and CBF values in NAWM or for severity of disability in patients with MS. The MS group showed prolonged mean transit time in the periventricular NAWM, as compared with the control group, and positive correlation was found between mean transit time values and disability scales in patients with MS. Conclusion:The data support a role of CCSVI in cerebral hemodynamic changes, such as a decrease of CBV and CBF, regardless of the presence of MS. CCSVI had no effect on neurologic function and disability progression in patients with MS.q RSNA, 2012

The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants

“…Even those DS studies which detected a significant difference for CCSVI diagnosis between MS patients and the controls, reported a substantially lower prevalence than was originally reported [30,31,83,88,90,92-94,98,99]. …”

Mystery of Chronic Cerebrospinal Venous Insufficiency: Identical Venographic and Ultrasound Findings in Patients with MS and Controls

“…[15][16][17][18]31 MR imaging venographic data have been mixed, with the sonographic findings not being replicated. 20,32 A combined sonography and MRV study 21 was not able to replicate the findings in 40 patients with MS. A recent MR imaging study by Garaci et al 33 demonstrated no significant specific interaction between the presence of chronic cerebrospinal venous insufficiency and MS in measured hemodynamic changes of mean transit time, cerebral blood flow, or volume. We undertook a study with experienced vascular sonographers, a vascular interventional neuroradiologist, and an MS neurologist and were unable to find a single case on sonography fulfilling the criteria of Zamboni et al 9 for chronic cerebrospinal venous insufficiency.…”

Concomitant Analysis of Arterial, Venous, and CSF Flows using Phase-Contrast MRI: A Quantitative Comparison Between MS Patients and Healthy Controls

“…29 Other possible underlying mechanisms were later suggested. Recent studies using MRI or metabolic PET studies 30,31 have highlighted a reduction of arterial inflow within the damaged white matter, particularly the periventricular normal-appearing white matter, 32,33 extending to the cerebral cortex and deep gray matter. Cerebral hypoperfusion in MS patients was mainly assumed to be secondary to reduced metabolic demand due to axonal degeneration.…”