ABSTRACT
Background: Chronic cerebrospinal venous insufficiency (CCSVI) was proposed as the causal trigger for developing multiple sclerosis (MS). However, current data are contradictory and a gold standard for venous flow assessment is missing.
Objective: To compare structural magnetic resonance venography (MRV) and dynamic extracranial color-coded duplex sonography (ECCS) in a cohort of patients with MS.
Methods: We enrolled 40 patients (44 ± 10 years). All underwent contrast-enhanced MRV for assessment of internal jugular vein (IJV) and azygos vein (AV) narrowing, graded into 3 groups: 0%–50%, 51%–80%, and >80%. ECCS analysis of blood flow direction, cross-sectional area (CSA), and blood volume flow (BVF) in both IJV and vertebral veins (VV) occurred in the supine and upright body position.
Results: MRV identified 1 AV narrowing. IJV analysis yielded 12 patients for group 1 (30%), 19 patients for group 2 (48%), and 9 patients for group 3 (22%). By ECCS criteria, 4 patients (10%) presented with venous drainage abnormalities. Jugular BVF was different only between groups 1 and 3 (616 ± 133 vs 381 ± 213 mL/min, p = 0.02). No other parameters in supine position and none of the parameters in the upright body position, apart from the IJV-BVF decrease in groups 1 and 3 (479 ± 172 vs 231 ± 144 mL/min, p = 0.01), were different.
Conclusions: Our ECCS data contradict the postulated 100% prevalence of CCSVI criteria in MS. MRV seems more sensitive to detect IJV narrowing compared to ECCS. A measurable hemodynamic effect only exists in vessel narrowings >80%. Our combined data argue against a causal relationship of venous narrowing and MS, favoring the rejection of the CCSVI hypothesis.
F. Doepp, MD, J.T. Würfel, MD, C.F. Pfueller, MD, J.M. Valdueza, MD, D. Petersen, MD, F. Paul, MD and S.J. Schreiber, MD
This is the full abstract. Dr. Doepp's team found CCSVI in the majority of MS patients using MRV. 70% of the patients had narrowings greater that 50% in their IJVs. He did not look at any healthy controls for comparison.
Using the doppler, a measureable hemodynamic effect was found when the narrowings are greater than 80%. I had two veins with that high grade of stenoses (80% in one, 99% in the other). He found 22% of pwMS had stenoses like this, greater than 80%, that had a measureable hemodynamic effect, which might be correctable through angioplasty.
He is looking at causation, which requires a very high degree of sensitivity and specificity (CCSVI is found in MS patients, it is not found in people without MS). We are not as interested in causation. Even smoking is not a cause of cancer, but a promoter of cancer. We are interested in CCSVI as a promoter of MS, as well as what happens to MS and to CCSVI symptoms when CCSVI is treated.
