Mult Scler. 2011 Dec 22. [Epub ahead of print]
Non-specific alterations of craniocervical venous drainage in multiple sclerosis revealed by cardiac-gated phase-contrast MRI.
Ertl-Wagner B, Koerte I, Kuempfel T, Blaschek A, Laubender RP, Schick M, Steffinger D, Kaufmann D, Heinen F, Reiser M, Alperin N, Hohlfeld R.
Institute of Clinical Radiology, University of Munich - Grosshadern Campus, Ludwig-Maximilians-University Munich, Germany.
Objective: There is an on-going controversy about venous drainage abnormalities in multiple sclerosis (MS). We applied cardiac-gated phase-contrast and venographic magnetic resonance (MR) techniques to compare venous drainage patterns in patients with MS, healthy controls, and subjects with migraine.
Methods: A total of 27 patients with MS (21 female, age 12-59 years, mean disease duration 8.4 ± 8.5 years) and 27 age- and gender-matched healthy controls (21 female, age 12-60 years) were investigated with velocity-encoded cine-phase contrast MR sequences and a 2D time-of-flight MR venography of the cervicocranial region on a 3-T MRI. The data were compared with 26 patients with chronic migraine headaches (19 female, age 17-62 years), previously investigated with the same protocol. The degree of primary and secondary venous outflow in relation to the total cerebral blood flow (tCBF) was compared both quantitatively and qualitatively. Statistical analyses were performed using linear regression models.
Results: Secondary venous outflow was significantly increased in patients with MS compared with healthy controls, both qualitatively (p < 0.001) and quantitatively (p < 0.013). The observed changes were independent of age and disease duration. Very similar alterations of venous drainage were detectable with the same approach in patients with migraine, without significant differences between MS and migraine patients (p = 0.65).
Conclusion: Our MRI-based study suggests that patients with MS have alterations of cerebral venous drainage similar to subjects with chronic migraine. These non-disease-specific changes seem to a secondary phenomenon rather than being of primary pathogenic importance.
I wonder what's going on with the migraine patients? If they have similiar drainage patterns as pwMS, do they have CCSVI as well?
Were there significant differences between the migraine patients and the healthy controls? It's not said.
There are cerebral blood flow irregularities in migraine, but I'm not familiar enough to know what they are.
I am not sure that this meaningfully shows that these alterations of venous drainage are a non-disease-specific change. It is only testing against one other disease, and one in which blood flow is known to be irregular. I am not convinced that MRI is the best imaging tool for flow. Dr. Zamboni tested against a number of neurological diseases and found CCSVI only in MS patients. Dr. Zivadinov found a higher percentage of CCSVI in other neurological diseases than in health controls, but not as high as in MS.
It is always interesting to see negative results published in neurology journals, and positive in vascular journals. Two different worlds, hearing two different things.