I read this paper, and while I admit most of it went over my head, I'm not sure why you say the tests done by the authors are so different from the ones done by Zamboni. It looks like they tested for other parameters they thought were useful (cerebral blood flow, jugular valve incompetence) in addition to Dr. Zamboni's criteria. The authors state as much:
The aim of this study was to (i) evaluate the ultrasound findings reported by Zamboni and co-workers suggesting a role of ‘CCSVI’ in the pathogenesis of MS, and (ii) to extend the studies they performed through acquisition of additional ultrasound indices such as blood volume flow (BVF) and internal jugular venous valve competence (Valsalva maneuvre) to more comprehensively evaluate the haemodynamic effects of any suspected cerebro-cervical venous congestion.
But they were familiar with Zamboni's 5 criteria:
Assessment of ‘CCSVI’ criteria. A specific effort was undertaken to search for the
presence of one or more of the following criteria by which ‘CCSVI’ has been defined (table 6): (i) a reflux >0.88 sec in the IJV and/or the VV, (ii) reflux in the deep cerebral veins (DCV), (iii) B-mode evidence of proximal IJV stenosis, defined as local reduction of CSA ≥ 50% in a recumbent position (0°), (iv) flow not Doppler detectable in both IJVs and/or both VVs (v) a missing IJV diameter decrease in the sitting position, so called “reverted postural control” of the main cerebral venous outflow pathways.
It looks like they used the Valsalva maneuver only to test for valve incompetence. They found 38% of the patients and 30% of the controls that had reflux during the Valsalva maneuver. Yet, in their comparison to Zamboni's criteria (in the article text and in the table at the end of the article) they list 0 as the number of patients/controls who showed >.88 sec. of reflux. So, apparently they are not counting those who showed reflux during the valsalva.
In a single patient with RRMS we detected a constant bi-directional flow in the left IJV in a supine position. This flow pattern turned into an orthograde flow when sitting up. In contrast to our findings Zamboni, et al. reported a reflux >0.88 sec in the IJVs and/or VVs in any body position in 70% of the patients with MS.11,12 The Doppler-sonographic observation of bi-directional flow in parts of the IJVs may be caused by a pulsation artifact from the nearby carotid artery and hence be misinterpreted as a venous reflux, particularly if blood flow measurements were not assessed along the entire IJV. VM testing seems a adequate method by which to detect venous reflux. In our study we detected IJVVI in 38% of MS patients, hence slightly more often than in our reference cohort as well as compared to values reported earlier.28 As Zamboni and
co-workers did not report analysis of IJV valve competence using VM it cannot be excluded that what they detected as reflux was rather caused by IJVVI then by stenosis.
The authors checked only one spot in the jugular and vertebral veins for the purposes of determining blood flow volume, an additional measurement they added. But for the purpose of testing criteria 3, B-mode evidence of proximal IJV stenosis, they did check the entire vein:
Regional narrowing of the IJV and VV was assessed by insonating their entire accessible length using the sagittal plane of the B-mode imaging. For assessment of the IJV additional measurements were obtained in the horizontal plane.
I can't say I really understand all of the possible reasons the authors give for their differences with Dr. Zamboni's results. It would be nice if they and Dr. Zamboni could discuss the discrepancies, but realistically this probably won't happen.