Validity of the diagnostic criteria for chronic cerebrospinal venous insufficiency and association with multiple sclerosis

Abstract

Background:The chronic cerebrospinal venous insufficiency theory proposes that altered cerebral venous hemodynamics play a role in the pathophysiology of multiple sclerosis. We aimed to explore the validity of this hypothesis by assessing the diagnostic criteria for chronic cerebrospinal venous insufficiency in persons with and without multiple sclerosis. Methods:We compared the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls using extracranial Doppler ultrasonography and gadolinium-enhanced magnetic resonance venography. Interpreting radiologists were blinded to the clinical status of participants. Results:We enrolled 120 patients with multiple sclerosis and 60 healthy controls. High proportions of both patients (67/115 [58%]) and controls (38/60 [63%]) met 1 or more of the proposed ultrasound criteria for diagnosis of chronic cerebrospinal venous insufficiency (p = 0.6). A minority of patients (23/115 [20%]) and controls (6/60 [10%]) fulfilled 2 or more of the proposed criteria (p = 0.1). There were no differences between patients and controls in the prevalence of each individual ultrasound criterion. Similarly, there were no differences in intracranial or extracranial venous patency between groups, as measured by magnetic resonance venography. Interpretation:We detected no differences in the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls. Moreover, our study revealed significant methodologic concerns regarding the proposed diagnostic criteria for chronic cerebrospinal venous insufficiency that challenge their validity. AbstractResearch CMAJ, August 5, 2014, 186(11) E419

Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study

“…These results are in line with previous findings of high variability of incidence of IJV stenosis on MS and, in particular, in HC. 8,9,21,26 Our results confirm that the occurrence of IJV stenosis in MS is not common enough to be defined as a feature of the disease; in addition, the high incidence of IJV stenosis in HC confirms that stenosis is related to a physiological variability rather than to a pathological condition. As a further validation of our result, a recent study 29 investigating the prevalence of incidental superior IJV narrowing in patients imaged AV-mismatch, arteriovenous mismatch; dIJVF, dominant internal jugular vein flow rate; IJV, internal jugular vein; nIJV, normalized internal jugular vein; SD, standard deviation; sdIJVF, subdominant internal jugular vein flow rate.…”

“…These studies used different image modalities such as ultrasound 3,5,[7][8][9][10][11][12][13][14] and MRI, including contrast-enhanced MR venography (CE-MRV), phasecontrast MRI or time-of-flight sequences, 4,[15][16][17][18][19][20] and a combination of different imaging modalities. [21][22][23][24][25][26] These studies, however, yielded somewhat conflicting results, and the role of venous abnormalities in MS still remains in discussion.…”

No Association of Chronic Cerebrospinal Venous Insufficiency with Multiple Sclerosis

“…14 Costello et al used both extracranial Doppler ultrasonography and magnetic resonance venography to test the CCSVI hypothesis and found no differences in CCSVI prevalence between patients and controls. 15 In the largest study to date, Comi et al found a CCSVI prevalence of 3.26% among 1165 MS patients and 2.13% among 376 non-MS controls. 16 As we have reported previously, different tools to assess for CCSVI and different interpretations of CCSVI criteria can alter the proportions of subjects meeting CCSVI criteria.…”

“Liberation treatment” for chronic cerebrospinal venous insufficiency in multiple sclerosis: the truth will set you free

“…Methodological magnetic resonance venography (Blinkenberg et al 2012;Brod et al 2013;Costello et al 2014) or catheter venography (Baracchini et al 2011;Traboulsee et al 2014). More specifically, the sensitivity and specificity of the ultrasound criteria for detection of greater than 50% narrowing of any major vein on catheter venography was 40.6% (95% CI: 31.1-50.8%) and 64.3% (48.0-78.0%) in a recent multicenter, double-blinded (blinding of both sonographers and neuro-interventionalists) Canadian study.…”