Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

Torres, Carlos; Hogan, Matthew J.; Patro, Satya; Chakraborty, Santanu; Nguyen, Thanh Binh; Thornhill, Rebecca E.; Freedman, Mark S.; Bussiére, Miguel; Dabirzadeh, Hamid; Schwarz, Betty Anne; Belanger, Stefanie; Legault-Kingstone, Lysa; Schweitzer, Mark E.; Lum, Cheemun

doi:10.1007/s00330-016-4314-6

Cited by 9 publications

(16 citation statements)

References 25 publications

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“…Increased intra-abdominal and intra-thoracic pressures have also been known to shunt blood through the vertebral and epidural networks 26 . Although HC are not exempt from having stenosis, and variations have been reported in non-disease states 11 , the percentage of stenotic HCs is far less (20%) than the percentage of ST-MS (55%); p<0.001. Of note, NST-MS flow is similar to HC for all venous types, whereas ST-MS patients show markedly reduced IJV flow and elevated Type II and III venous flow compared to non-stenotic counterparts and controls.…”

Section: Discussionmentioning

confidence: 89%

“…A pilot study by Zamboni also showed that HCs tend to drain blood via the IJVs as opposed to collaterals 27 . Torres and colleagues, however, found that recruitment of extracranial veins as collaterals was a common finding in non-MS patients using contrast-enhanced magnetic resonance angiography and venography imaging 11 . Zivadinov et al reported no evidence of increased collaterals in MS using TOF and TRICKS imaging 28 .…”

Section: Discussionmentioning

confidence: 99%

“…The extra-jugular drainage system consists of the vertebral venous system, the deep cervical veins (DCV) which anatomically are paraspinal towards the heart, and the anterior and external jugular veins (AJV and EJV), which receive blood from facial and superficial areas 8 . Although the presence and structure of collateral veins has been assessed using TRICKS venography, flow values were not quantitatively evaluated 9–11 . The purpose of this work is to examine the relation of extracranial venous anatomy and flow in a large cohort of MS patients and HC taken from our neuroimaging database 12 .…”

Section: Introductionmentioning

confidence: 99%

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Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow

Sethi

Daugherty

Gadda

et al. 2017

AJNR Am J Neuroradiol

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Background and Purpose To date, research on extracranial venous collaterals has been focused on structure, with relatively little attention paid to hemodynamics. We address this limitation by quantitatively comparing collateral flow in multiple sclerosis (MS) patients and healthy controls (HC) using Phase-Contrast (PC) MRI. We hypothesize that MS patients with structurally anomalous internal jugular veins (IJVs) will have elevated collateral venous flow compared to HC. Methods The sample consisted of 276 MS patients and 106 HC. We used MRV to classify IJVs as stenotic (ST) and non-stenotic (NST), based on an absolute cross-sectional area threshold in 276 MS patients and 60 HC, 46 HC lacked this imaging. Individual and total vessel flows were quantified using PC MRI on all subjects. Veins were classified by extracranial drainage type: IJV (I), paraspinal (II), and superficial (III). Differences among HC, MS, non-ST (NST), and ST subgroups in total venous flow by vessel type were evaluated in a general linear model for statistical analysis. Results In the MS group, 153 (55%) evidenced ST, while 12 (20%) HC classified as ST (p<0.001). Compared to HC, the MS group showed lower Type I flow, and increased Type II flow. Stenosis was associated with reduced flow in the Type I vessels: F(1,272)=68, p<0.001. The ST-MS group had increased flow in the Type II vessels compared to NST-MS; F(1,272)=67, p<0.001. Conclusion Compared to HC, MS patients exhibit reduced venous flow in the main extracerebral drainage vein (IJV). In contrast, flow in the paraspinal venous collaterals is elevated in MS patients and exacerbated by venous stenosis. Collateral drainage may be a compensatory response to IJV flow reduction.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow

Sethi

Daugherty

Gadda

et al. 2017

AJNR Am J Neuroradiol

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“…However, it is still controversial whether CCSVI is normal variation or pathological change, because of the superficial position of IJV easily being invaded, the debatable significance of cerebrospinal venous collateral circulation, and the indefinite relationship between CCSVI and clinical symptoms (11,12). It is difficult to carry out in-depth studies due to the lack of a systematic clinical classification and a universal diagnostic criterion based on imaging evidence.…”

Section: Introductionmentioning

confidence: 99%

Clinical Classification and Collateral Circulation in Chronic Cerebrospinal Venous Insufficiency

et al. 2020

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Background: As an indispensable part of the cerebral venous system, the extracranial cerebrospinal venous system is not fully recognized. This study aimed to analyze the clinical classification and imaging characteristics of chronic cerebrospinal venous insufficiency (CCSVI) quantitatively. Methods: A total of 128 patients, who were diagnosed as CCSVI by jugular ultrasound and contrast-enhanced magnetic resonance venography (CE-MRV), were enrolled from May 2018 through May 2019. For the patients with possible extraluminal compression, computed tomography venography (CTV) was applied to estimate the degree of internal jugular venous stenosis (IJVS) and rank the vertebral venous collateral circulation. Results: The causes of extraluminal compression induced IJVS included osseous compression (78.95%), carotid artery (24.21%), sternocleidomastoid muscle (5.79%), swollen lymph node (1.05%), and unknown reasons (5.26%). The subtypes of non-compression CCSVI included the high jugular bulb (77.27%), fenestration of the internal jugular vein (IJV) (7.27%), internal jugular phlebectasia (2.73%), tortuous IJV (0.91%), IJV thrombosis (14.55%), and elongated venous valves with/without erythrocyte aggregation (13.64%). For extraluminal compression induced IJVS, the ratio of severe vertebral venous expansion was higher in the severe IJVS group than that in the mild IJVS group (p < 0.001). The IJVS degree was higher in the severe vertebral venous expansion group than in the mild vertebral venous expansion group (p < 0.001). Conclusions: A multimodal diagnostic system is necessary to improve the diagnostic accuracy of CCSVI. The vertebral venous system is an important collateral circulation for CCSVI, which may be a promising indicator for evaluating IJVS degree.

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“…3-5 CCSVI may induce venous reflux and cerebral venous hypertension, resulting in brain-blood barrier (BBB) integrity disruption and peri-venous iron accumulation, 6, 7 decreased cerebral brain flow (CBF), 8, 9 which further led to chronic cerebral hypoxia, inflammatory cells infiltration into brain parenchyma and even local inflammatory process. 10,11 Our previous work demonstrated the neutrophil-to-lymphocyte ratio (NLR) 12 and red blood cell distribution width (RDW) 13 were negative diagnostic and prognostic markers for acute ischemic stroke (AIS). Furthermore, inflammation biomarkers, for instance, NLR, hypersensitive C-reactive protein (Hs-CRP), interleukin-6 (IL-6) was correlated with the severity and outcome of cerebral venous thrombosis (CVT).…”

Section: Introductionmentioning

confidence: 99%

Inflammatory Biomarkers May Predict Poor Outcome in Patients with Chronic Cerebrospinal Venous Insufficiency.

Meng

Lan

et al. 2020

Preprint

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Background and purpose Chronic cerebrospinal venous insufficiency (CCSVI) related inflammatory process is still unclear. This study aimed to evaluate peripheral inflammatory biomarkers in both intracranial CCSVI and the extracranial CCSVI group, as well as the relationship between the inflammatory state and prognosis of CCSVI.Methods Patients with CCSVI were included from July 2017 to July 2019, divided into three groups by location of stenosis. The inflammatory biomarker assay included neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width (RDW), C-reactive protein (CRP), interleukin- 6 (IL-6)) and neuron-specific enolase (NSE). The clinical outcome was assessed by the modified Rankin Scale (mRS) and Patient Global Impression of Change (PGIC) score. Univariate and multivariate regression analysis was performed to identify significant prognostic factors for poor outcome. Then a nomogram based on multivariate regression analysis was established.Results In total, 248 consecutive patients were enrolled, 102 males and 146 females, with an average age of 57.85 ± 12.28 years. Patients with cerebral venous sinus stenosis (CVSS) were more likely to be younger age and present headaches and severe papilledema. Higher levels of NLR, RDW, and CRP were also observed in the CVSS group. In multivariate analysis, NLR, PLR, and IL-6 became the independent prognostic factors for predicting the poor outcome of CCSVI.Conclusions The clinical presentations and the increased levels of NLR, PLR, and CRP may be more remarkable in the group with CVSS-related CCSVI than that with internal jugular venous stenosis (IJVS)-related CCSVI. The pro-inflammatory state may relate to CCSVI. An elevated level of NLR, PLR, and IL-6 played a negative role in the prognosis of CCSVI.

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Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

Cited by 9 publications

References 25 publications

Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow

Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow

Clinical Classification and Collateral Circulation in Chronic Cerebrospinal Venous Insufficiency

Inflammatory Biomarkers May Predict Poor Outcome in Patients with Chronic Cerebrospinal Venous Insufficiency.

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