Neck duplex Doppler ultrasound evaluation for assessing chronic cerebrospinal venous insufficiency in multiple sclerosis patients

Zaniewski, Maciej; Kostecki, Jacek; Kuczmik, Wacław; Ziaja, Damian; Opala, Grzegorz; Świat, Maciej; Korzeniowski, Tomasz; Majewski, Eugeniusz; Urbanek, Tomasz; Pawlicki, Krzysztof

doi:10.1258/phleb.2011.011070

Cited by 28 publications

(25 citation statements)

References 19 publications

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“…2,3,5,7,8,16,17 Although two independent systematic reviews point towards a possible association between CCSVI and MS, definitive conclusions could not be made, owing to the substantial variation in the strength of the association, lack of blinding and heterogeneity between studies. 20,25 Previous studies about CCSVI have limitations, such as: lack of an adequate number of controls, monocentric design and incorrect/absent blinding (Table 1). To address these, we adopted a stringent methodology in the design of the CoSMo study, whereby blinding procedures were adopted by local and central readers, a multicentric design was used and the study included a large sample size, appropriate controls and healthy individuals.…”

Section: Discussionmentioning

confidence: 99%

Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study

et al. 2013

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Background: Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a possible cause of multiple sclerosis (MS). Objectives: The CoSMo study evaluated the association between CCSVI and MS. Methods: The primary end-point of this multicentric, case-control study was to compare the prevalence of CCSVI between patients with MS, patients with other neurodegenerative diseases (ONDs) and healthy controls (HCs). Color-coded duplex sonography was performed by a sonologist and the images were sent to one of three central sonologists for a second reading. Agreement between local and central sonologists or, in case of disagreement, the predominant judgment among the three central readers, was required for a diagnosis of CCSVI. All readings, data collection and analysis were blinded. Results: The study involved 35 MS centers across Italy and included 1874 subjects aged 18-55. 1767 (94%) were evaluable: 1165 MS patients, 226 patients with ONDs and 376 HCs. CCSVI prevalence was 3.26%, 3.10% and 2.13% for the MS, OND and HC groups, respectively. No significant difference in CCSVI prevalence was found amongst the three cohorts (MS versus HC, OR = 1.55, 95%CI = 0.72-3.36, p = 0.30; OND versus HC, OR = 1.47, 95%CI = 0.53-4.11, p = 0.46; MS versus OND, OR = 1.05, 95%CI = 0.47-2.39, p = 0.99). High negative and low positive agreement was found between the local and centralized readers. Conclusions: CCSVI is not associated with MS.

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Section: Discussionmentioning

confidence: 99%

Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study

et al. 2013

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“…[3][4][5][6][7][8] Lack of blinding, variable interpretation of the Zamboni ultrasound criteria, and differing case-mixes may all contribute to these inconsistent results.…”

Section: Introductionmentioning

confidence: 99%

Chronic cerebrospinal venous insufficiency is not more prevalent in patients with mild multiple sclerosis: a sonographer-blinded, case-control ultrasound study

Chambers

Cameron

et al. 2012

Mult Scler

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Objectives:We designed a prospective case-control study of patients with clinically isolated syndrome (CIS) and Relapsing-Remitting Multiple Sclerosis (RRMS) with an Expanded Disability Status Score (EDSS) of ≤2, compared with age-and-sex-matched healthy controls, to test the hypothesis that chronic cerebrospinal venous insufficiency (CCSVI) is more prevalent in patients with CIS or mild MS. Methods: All subjects were examined using a Siemens Antares duplex ultrasound machine. The internal jugular, vertebral and intracranial veins were studied in subjects in both supine and sitting postures. The sonographer was blind to the subject's clinical status. Measures included the criteria proposed by Zamboni and volume flow. Presence of CCSVI was defined as ≥2 Zamboni criteria. Results: Seventy patient-control pairs were recruited, with 11 males and 59 females in each group. Only one subject, a control, satisfied the Zamboni definition of CCSVI; however, 19 patients and 13 controls had abnormalities as defined by Zamboni, the difference largely caused by a higher prevalence in patients of internal jugular vein (IJV) stenosis, defined as a cross-sectional area ≤0.3cm 2 . This difference disappeared with a more rigorous stenosis definition. Further analysis revealed there was IJV valve variation in seven patients and one control. Conclusions: Our findings indicate that CCSVI, as defined by the Zamboni ultrasound criteria, is not present in CIS and mild RRMS (EDSS ≤2), providing further evidence that CCSVI does not have a causal role in MS; however, we found an apparent increase in IJV variation in patients with CIS or mild MS that would warrant further investigation.

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“…This theory holds that increased venous pressure could be the main reason for the formation of colloids, lymphocyte and erythrocyte extravasation, promoting an inflammatory reaction in the brain and spine in cases of MS [42]. Evidence of pathogenesis shows a close association between chronic cerebrospinal venous inhibitions (CCSVI) to MS supporting the pathogenetic theory (Table 1) [42][43][44][45][46][47][48][49]. It is possible that this is also the cause of neurodegeneration in AD.…”

Section: Causes Of Alzheimer's Diseasementioning

confidence: 92%

A Current Understanding of Alzheimers Disease and the Prospects of Phytopharmacological Intervention as a Management Strategy

Kk¹

2015

J Neurol Disord

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Neck duplex Doppler ultrasound evaluation for assessing chronic cerebrospinal venous insufficiency in multiple sclerosis patients

Abstract: The examinations undertaken indicate a possible connection between MS and CCSVI. The widely accessible and highly sensitive and specific Doppler ultrasound test may be useful for revealing, and preliminary analysis of, CCSVI pathologies.

Cited by 28 publications

References 19 publications

Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study

Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study

Chronic cerebrospinal venous insufficiency is not more prevalent in patients with mild multiple sclerosis: a sonographer-blinded, case-control ultrasound study

A Current Understanding of Alzheimers Disease and the Prospects of Phytopharmacological Intervention as a Management Strategy

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