1. Chronic cerebrospinal venous insufficiency: masked multimodal imaging assessment.
- Author
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Brod SA, Kramer LA, Cohen AM, Barreto AD, Bui TT, Jemelka JR, Ton K, Lindsey JW, Nelson F, Narayana PA, and Wolinsky JS
- Subjects
- Adult, Case-Control Studies, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Multiple Sclerosis complications, Multiple Sclerosis etiology, Phlebography methods, Ultrasonography, Doppler methods, Venous Insufficiency complications, Venous Insufficiency diagnosis, Brain blood supply, Multimodal Imaging methods, Multiple Sclerosis pathology, Spinal Cord blood supply, Venous Insufficiency epidemiology
- Abstract
Background: Chronic cerebrospinal venous insufficiency (CCSVI) was implicated in the pathophysiology of multiple sclerosis (MS)., Objective: We evaluated neurosonography (NS), magnetic resonance venography (MRV), and transluminal venography (TLV) in subsets of MS patients drawn from a single-center, prospective, case-control study of 206 MS and 70 non-MS volunteers., Methods: As previously reported, findings on high-resolution B-mode NS imaging with color and spectral Doppler of the extracranial and intracranial venous drainage consistent with CCSVI were similar among MS and non-MS volunteers (3.88% vs 7.14%; p = 0.266). Ninety-nine MS participants consented to intravascular contrast-enhanced 3D MRV to assess their major systemic and intracranial venous circulation, and 40 advanced to TLV that included pressure measurements of the superior vena cava, internal jugular, brachiocephalic, and azygous veins., Results: NS findings and MRV patterns were discrepant for 26/98 evaluable subjects, including four with abnormal findings on NS that had normal venous anatomy by MRV. In no instance were TLV pressure gradients indicative of clinically significant functional stenosis encountered. The three imaging approaches provided generally consistent data with discrepancies referable to inherent technique properties., Conclusions: Our findings lend no support for altered venous outflow dynamics as common among MS patients, nor do they likely contribute to the disease process.
- Published
- 2013
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