The Hypothesis of Pathophysiological Correlation between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis: Rationale of Treatment

Lugli, Marzia; Morelli, M. C.; Guerzoni, S; Maleti, Oscar

doi:10.1258/phleb.2012.012s24

Cited by 25 publications

(26 citation statements)

References 19 publications

(39 reference statements)

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“…The sensitivity of CV + IVUS to define total IJV pathology on DS was 100%. These findings support results from the 2 previous studies in which a higher sensitivity of DS to detect extracranial anomalies on IVUS compared to CV was found in the IJVs [27,30]. These results can also explain findings from some recent reports that found low correspondence between the DS screening assessment and the CV findings [9,31].…”

Section: Discussionsupporting

confidence: 90%

“…A growing body of evidence suggests that the majority of CCSVI pathology is confined to the intra-luminal portion of extracranial veins, which requires high-resolution DS or IVUS B-mode imaging for the visualization of these anomalies [8,26,27]. It has been shown that the presence and number of these anomalies may contribute to a higher number of collateral neck veins and functional abnormalities [8,27].…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that the presence and number of these anomalies may contribute to a higher number of collateral neck veins and functional abnormalities [8,27]. While CV is considered to be "the gold standard - benchmark" for detecting stenosis in blood vessels associated with altered blood flow, the PREMiSe study showed that CV may not be sensitive enough to reveal the exact nature of narrowed vein segments [25].…”

Section: Discussionmentioning

confidence: 99%

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Multimodal noninvasive and invasive imaging of extracranial venous abnormalities indicative of CCSVI: Results of the PREMiSe pilot study

et al. 2013

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BackgroundThere is no established noninvasive or invasive diagnostic imaging modality at present that can serve as a ‘gold standard’ or “benchmark” for the detection of the venous anomalies, indicative of chronic cerebrospinal venous insufficiency (CCSVI). We investigated the sensitivity and specificity of 2 invasive vs. 2 noninvasive imaging techniques for the detection of extracranial venous anomalies in the internal jugular veins (IJVs) and azygos vein/vertebral veins (VVs) in patients with multiple sclerosis (MS).MethodsThe data for this multimodal imaging comparison pilot study was collected in phase 2 of the “Prospective Randomized Endovascular therapy in Multiple Sclerosis” (PREMiSe) study using standardized imaging techniques. Thirty MS subjects were screened initially with Doppler sonography (DS), out of which 10 did not fulfill noninvasive screening procedure requirements on DS that consisted of ≥2 venous hemodynamic extracranial criteria. Accordingly, 20 MS patients with relapsing MS were enrolled into the multimodal diagnostic imaging study. For magnetic resonance venography (MRV), IJVs abnormal findings were considered absent or pinpoint flow, whereas abnormal VVs flow was classified as absent. Abnormalities of the VVs were determined only using non-invasive testing. Catheter venography (CV) was considered abnormal when ≥50% lumen restriction was detected, while intravascular ultrasound (IVUS) was considered abnormal when ≥50% restriction of the lumen or intra-luminal defects or reduced pulsatility was found. Non-invasive and invasive imaging modality comparisons between left, right and total IJVs and between the VVs and azygos vein were performed. Because there is no reliable way of non-invasively assessing the azygos vein, the VVs abnormalities detected by the non-invasive testing were compared to the azygos abnormalities detected by the invasive testing. All image modalities were analyzed in a blinded manner by more than one viewer, upon which consensus was reached. The sensitivity and specificity were calculated using contingency tables denoting the presence or absence of vein-specific abnormality findings between all imaging modalities used individually as the benchmark.ResultsThe sensitivity of CV + IVUS was 68.4% for the right and 90% for the left IJV and 85.7% for the azygos vein/VVs, compared to venous anomalies detected on DS. Compared to the venous anomalies detected on MRV, the sensitivity of CV + IVUS was 71.4% in right and 100% in left IJVs and 100% in the azygos vein/VVs; however, the specificity was 38.5%, 38.9% and 11.8%, respectively. The sensitivity between the two invasive imaging techniques, used as benchmarks, ranged from 72.7% for the right IJV to 90% for the azygos vein but the IVUS showed a higher rate of venous anomalies than the CV. There was excellent correspondence between identifying collateral veins on MRV and CV.ConclusionsNoninvasive DS screening for the detection of venous anomalies indicative of CCSVI may be a reliable approach for identifying patients eligible for ...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multimodal noninvasive and invasive imaging of extracranial venous abnormalities indicative of CCSVI: Results of the PREMiSe pilot study

et al. 2013

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“…The prevalence of these lesions was over 50% 32,33 and was even higher (about 90%) when more liberal definition of an abnormality or IVUS were used. 1,[20][21][22][23][24][25][26][27]104 Similarly, the results of MRV studies were quite consistent, ie, IJV stenoses were found in 25%-70% of patients with multiple sclerosis, 30,32,36,37,39,40,44,46,49 which is comparable with the results of catheter venography. A lower frequency of IJV abnormalities revealed by MRV probably resulted from the fact that this imaging modality cannot precisely assess the jugular valve, which is the most common site of CCSVI pathology.…”

supporting

confidence: 61%

Chronic cerebrospinal venous insufficiency: current perspectives

Simka¹

2014

JVD

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“…Unfortunately, published guidelines do not give a clear definition of such pathological intraluminal structures [12,20]. Undoubtedly, this part of sonographic assessment of IJVs needs clarification, and perhaps intravascular ultrasound (IVUS), instead of standard sonography, should be used to distinguish normal from pathological valves [16,29,30].…”

Section: Discussionmentioning

confidence: 99%

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

Hartel¹,

Kluczewska²,

Simka³

2015

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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.

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The Hypothesis of Pathophysiological Correlation between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis: Rationale of Treatment

Abstract: The pathophysiology of CCSVI is yet to be defined. The superior cava venous system is highly complex in terms of anatomy and possible anomalies, as well as its haemodynamic mechanisms. Further studies are required to define the parameters of diagnosis and treatment of CCSVI.

Cited by 25 publications

References 19 publications

Multimodal noninvasive and invasive imaging of extracranial venous abnormalities indicative of CCSVI: Results of the PREMiSe pilot study

Multimodal noninvasive and invasive imaging of extracranial venous abnormalities indicative of CCSVI: Results of the PREMiSe pilot study

Chronic cerebrospinal venous insufficiency: current perspectives

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

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