Chronic cerebrospinal venous insufficiency
Case–control neurosonography results
Article first published online: 26 FEB 2013
© 2013 American Neurological Association
Annals of Neurology
Volume 73, Issue 6, pages 721–728, June 2013
How to Cite
Barreto, A. D., Brod, S. A., Bui, T.-T., Jemelka, J. R., Kramer, L. A., Ton, K., Cohen, A. M., Lindsey, J. W., Nelson, F., Narayana, P. A. and Wolinsky, J. S. (2013), Chronic cerebrospinal venous insufficiency. Ann Neurol., 73: 721–728. doi: 10.1002/ana.23839
- Issue published online: 18 JUL 2013
- Article first published online: 26 FEB 2013
- Accepted manuscript online: 13 DEC 2012 04:43AM EST
- Manuscript Accepted: 7 DEC 2012
- Manuscript Revised: 5 DEC 2012
- Manuscript Received: 25 SEP 2012
Chronic cerebrospinal venous insufficiency (CCSVI) has been implicated in the pathophysiology of multiple sclerosis (MS). We sought to determine whether neurosonography (NS) provides reliable information on cerebral venous outflow patterns specific to MS.
This was a single-center, prospective case–control study of volunteer MS and non-MS participants. A neurosonologist, blind to the subjects' diagnosis, used high-resolution B-mode imaging with color and spectral Doppler to systematically investigate, capture, and record extracranial and intracranial venous drainage. These neuroimaging results were evaluated and scored by an expert blinded to subjects' information and with no interactions with the participants.
Altogether, 276 subjects were studied: 206 with MS and 70 non-MS. MS patients were older than non-MS subjects (48.3±9.9 vs 44.3±11.8 years, p<0.007), with durations from first symptoms and diagnosis of 13.7±10 and 9.9±7.8 years, and Expanded Disability Status Scale of 2.6±2.0. Overall, 82 subjects (29.7%) fulfilled 1 of 5 NS criteria proposed for CCSVI; 13 (4.7%) fulfilled 2 criteria required for diagnosis, and none fulfilled >2 criteria. The distribution of subjects with 0, 1, or 2 criteria did not differ significantly across all diagnostic groupings, between MS and non-MS subjects, or within MS subgroups. CCSVI was present in 7.14% of non-MS and 3.88% of MS patients (p=0.266). No significant differences emerged between MS and non-MS subjects for extracranial or intracranial venous flow rates.
NS findings described as CCSVI are much less prevalent than initially reported, and do not distinguish MS from other subjects. Our findings do not support the hypothesis that CCSVI is causally associated with MS. ANN NEUROL 2013;73:721–728