Is there any relation between chronic cerebrospinal venous insufficiency and multiple sclerosis? – a critical review

Jedynak, Waldemar; Cieszanowski, Andrzej

doi:10.12659/pjr.890379

Cited by 4 publications

(1 citation statement)

References 39 publications

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“…Based on these findings, some authors have claimed the suspension of angioplasty procedures of the extracranial veins. 13,14 Although, ECD studies are greatly influenced depending on the individual patients (different ages, differences in clinical forms and disability, physiological factors such as head position, hydration status and different degrees of cervical muscle relaxation and breathing) and operators, showing high inter-observer variability for untrained examiners, 15 only two studies have been conducted with the new ISNVD criteria. 16,17 In fact, apart from these only exceptions, all studies regarding CCSVI published after the revised protocol in 2011 continued to adopt the old criteria, affecting the results of the meta-analysis, because of the low agreement of the former criteria.…”

Section: Introductionmentioning

confidence: 99%

New Criteria Reduce Inter-Observer Variability in Chronic Cerebrospinal Venous Insufficiency: A Case Control Study

Farina¹,

Novelli²,

Pagani³

2017

Neuro – Open Journal

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Background: The pathophysiological mechanism defined "chronic cerebrospinal venous insufficiency" (CCSVI) diagnosed using Zamboni criteria has raised a heated debate about possible correlations with several neurological disorders, but also on subjectivity of these ultrasonographic criteria used for its diagnosis. Although in 2011 new criteria have been introduced to reduce the high inter-observer variability only two studies were conducted according to the new investigation protocol. Therefore, we wanted to verify the impact of the revised protocol and its ability to meet the demand for reduction of the high heterogeneity in inter-observer agreement. Patients and Methods: Between June 2010 and June 2014, 1020 subjects (693 MS patients and 327 HCs) were prospectively screened for CCSVI by two investigators, blinded regarding the observed subject. After exclusion of discordant cases between the two examiners, 630 patients with clinically defined MS and 10 patients with CIS (clinically isolated syndrome) were matched by gender (male 38.7%, male/female 248/392) and age (mean age 44.0 years, range 18.5-77.0 years) with 315 HCs (male 43.2%, male/female 136/179-mean age 46.5 years, range 19.8-79.9 years). Results: The prevalence of CCSVI in MS subjects before the introduction of the new ECD criteria (94.3%) was observed to be significantly reduced (83.4%) after their introduction (p<0.001). In MS patients, the strength of inter-observer agreement changed from moderate (k=0.532) to good (k=0.761) before/after the revision. B-mode analysis detected only 65.7% of valvular defects. Its diagnostic accuracy was 88.6% (95% CI: 84.0%-93.2%), with a sensitivity of 83.5% (95% CI: 75.2%-89.9%), a specificity of 96.0% (95% CI: 88.8%-99.2%), a positive predictive value of 96.8% (95% CI: 91.0%-99.3%) and a negative predictive value of 80.0% (95% CI: 70.3%-87.7%). Conclusions:The new ECD criteria introduced by the revised protocol ensure, at this time, a substantial reduction of the inter-observer variability. Under this perspective, M-mode analysis is essential for its ability to identify the valvular abnormalities frequently not detectable by Bmode analysis.

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Section: Introductionmentioning

confidence: 99%

New Criteria Reduce Inter-Observer Variability in Chronic Cerebrospinal Venous Insufficiency: A Case Control Study

Farina¹,

Novelli²,

Pagani³

2017

Neuro – Open Journal

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Developmental venous anomalies in patients with multiple sclerosis: is that a coincidence or an ancillary finding?

Grazzini

Calchetti

Cuneo³

2020

Neurol Sci

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Microvascular blood flow velocities measured with a retinal function imager: inter-eye correlations in healthy controls and an exploration in multiple sclerosis

et al. 2018

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BackgroundThe retinal microcirculation has been studied in various diseases including multiple sclerosis (MS). However, inter-eye correlations and potential differences of the retinal blood flow velocity (BFV) remain largely unstudied but may be important in guiding eye selection as well as the design and interpretation of studies assessing or utilizing retinal BFV. The primary aim of this study was to determine inter-eye correlations in BFVs in healthy controls (HCs). Since prior studies raise the possibility of reduced BFV in MS eyes, a secondary aim was to compare retinal BFVs between MS eyes, grouped based on optic neuritis (ON) history and HC eyes.MethodsMacular arteriole and venule BFVs were determined using a retinal function imager (RFI) in both eyes of 20 HCs. One eye from a total of 38 MS patients comprising 13 eyes with ON (MSON) and 25 eyes without ON (MSNON) history were similarly imaged with RFI.ResultsOD (right) and OS (left) BFVs were not significantly different in arterioles (OD: 3.95 ± 0.59 mm/s; OS: 4.08 ± 0.60 mm/s, P = 0.10) or venules (OD: 3.11 ± 0.46 mm/s; OS: 3.23 ± 0.52 mm/s, P = 0.06) in HCs. Very strong inter-eye correlations were also found between arteriolar (r = 0.84, P < 0.001) and venular (r = 0.87, P < 0.001) BFVs in HCs. Arteriolar (3.48 ± 0.88 mm/s) and venular (2.75 ± 0.53 mm/s) BFVs in MSNON eyes were significantly lower than in HC eyes (P = 0.009 and P = 0.005, respectively). Similarly, arteriolar (3.59 ± 0.69 mm/s) and venular (2.80 ± 0.45 mm/s) BFVs in MSON eyes were also significantly lower than in HC eyes (P = 0.046 and P = 0.048, respectively). Arteriolar and venular BFVs in MSON and MSNON eyes did not differ from each other (P = 0.42 and P = 0.48, respectively).ConclusionsInter-eye arteriolar and venular BFVs do not differ significantly in HCs and are strongly correlated. Our findings support prior observations that arteriolar and venular BFVs may be reduced in MS eyes. Moreover, this seems to be the case in both MS eyes with and without a history of ON, raising the possibility of global blood flow alterations in MS. Future larger studies are needed to assess differences in BFVs between MSON and MSNON eyes.

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Is there any relation between chronic cerebrospinal venous insufficiency and multiple sclerosis? – a critical review

Cited by 4 publications

References 39 publications

New Criteria Reduce Inter-Observer Variability in Chronic Cerebrospinal Venous Insufficiency: A Case Control Study

New Criteria Reduce Inter-Observer Variability in Chronic Cerebrospinal Venous Insufficiency: A Case Control Study

Developmental venous anomalies in patients with multiple sclerosis: is that a coincidence or an ancillary finding?

Microvascular blood flow velocities measured with a retinal function imager: inter-eye correlations in healthy controls and an exploration in multiple sclerosis

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