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

Abstract

Objectives: This prospective study was aimed at evaluation of diagnostic value of Doppler sonography and magnetic resonance (MR) venography in the internal jugular vein territory. Material and methods: There were assessed 126 patients (252 internal jugular veins). The patients were initially diagnosed using Doppler sonography and MR venography, and then catheter venography of the veins was performed. For the purpose of this study catheter venography was regarded the reference test. We interpreted sonographic findings in the context of criteria proposed by Zamboni and criteria by International Society for Neurovascular Disease (ISNVD). We applied MR protocols aimed at flow assessment in the scanned veins: fast spin echo-T2-weighted sequences with fat saturation, and axial two-dimensional time-of-flight imaging with saturation band positioned below planned slices. Results: Catheter venography revealed lesions in 171 (67.9%) of the veins studied, primarily stenotic jugular valves (88.0% of abnormal veins). We found that sonographic criteria, using either Zamboni or ISNVD criteria were of poor diagnostic accuracy (Cohen's k coefficient < 0.1). MR venography with the use of our dedicated protocols appeared to be a slightly better diagnostic tool (k about 0.4). Conclusions:The results of our MR imaging protocols for the assessment of abnormalities in internal jugular veins were better if compared to Doppler sonography. Yet, even MR venography was far from being perfect and at the moment neither this examination nor Doppler sonography cannot replace invasive catheter venography and should not be used as a definitive test for diagnosing anatomical and functional abnormalities in the internal jugular veins.