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Venous extracranial Duplex ultrasound and possible correlations between multiple sclerosis and CCSVI: an observational study after 560 exams
P. M. BAVERA 1, L. MENDOZZI 2, R. CAVARRETTA 2, G. B. AGUS 3

The article concerns an observational study subsequent to 560 Duplex ultrasound (DU) exams on multiple sclerosis affected patients. The aim of the study was to find out, after the so-called “Zamboni Theory”, if there may be any correlations between chronic cerebrospinal venous insufficiency (CCSVI) and Multiple Sclerosis (MS). All the patients had a certain diagnosis for MS and all exams were carried out, with a group of control in non-MS patients, by the same operator using two similar but different brand Duplex devices following the same procedure. The aim was to find any possible malformation in the extracranial venous cerebral outflow, mainly concerning the internal jugular vein and vertebral plexus system. Outflow malformations due to significantly reduced vein diameter and/or valve flaps were seeked both in horizontal and upright position. The results were interesting considering the constant presence of venous outflow problems in a significant number of patients affected by SM disease. The diagnosis percentage happened to be very similar, and significant, using either DU devices

Abnormalities regarding blood flow and morphology together with the chromatic aspects were present in 88% of the examined patients (493 patients). The exams were all carried out by the same operator using two different DU machines, revealing almost identical abnormality percentages (387 with the GE and 106 with the Esaote). This confirms that when inside instrument equality for probes and settings, the exam is mainly operator dependant and not vice versa.

The premises that revealed to be mostly interested (among the 493 patients positive for two or more pa- rameters) by stenosis and/or valve abnormalities are here shown in Table I.

Table I.—Site and type of abnormalities.
– Abnormal valves at the junction between jugular veins with the brachio cephalic vein in 333 cases (67.5%) of which 274 bilat- eral and 59 monolateral.
– Reflux of the internal jugular vein in 258 patients (52.3%).
– Reflux of the vertebral plexus in 266 patients (54%)
– Stenosis of internal jugular veins in 431 patients (87.5%) with vein calliper reduction over 70% of the normal lumen.
– High frequency blood flow turbulence and chromatic changes that appear to he “hemodynamically significant” in correspond- ence with the stenosis and /or valve abnormalities.
– Cross section negative difference of the jugular transverse area in the supine/upright position in 212 patients (43%).
– Complete occlusion or agenesia of one internal jugular vein in 10 patients (2.1%).

Within the group of examined positive patients, considering that VHISS parameters were at least 2/5 in 451 (91.5%) patients and 3/5 in 42 (8.5%), a certain correlation between SM and CCSVI appears rather evident.

Abnormalities regarding blood flow and morphology together with the chromatic aspects were present in 88% of the examined patients (493 patients).

Within the group of examined positive patients, considering that VHISS parameters were at least 2/5 in 451 (91.5%) patients and 3/5 in 42 (8.5%), a certain correlation between SM and CCSVI appears rather evident.