RSNA 2010 

Abstract Archives of the RSNA, 2010


SSK11-05

Comparison of Magnetic Resonance Imaging and Contrast Venography in the Evaluation of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis Patients

Scientific Formal (Paper) Presentations

Presented on December 1, 2010
Presented as part of SSK11: ISP: Neuroradiology (Multiple Sclerosis)

Participants

Greg Zaharchuk MD, PhD, Presenter: Advisory Board Member, General Electric Company Research support, General Electric Company
Michael David Dake MD, Abstract Co-Author: Scientific Advisory Board, W. L. Gore & Associates, Inc Scientific Advisory Board, Abbott Laboratories Scientific Advisory Board, Medtronic, Inc Research grant, Siemens AG Research grant, Cook Group Incorporated
John P. Cooke MD, PhD, Abstract Co-Author: Nothing to Disclose
Robert J. Herfkens MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

The concept of chronic cerebrospinal venous insufficiency (CCSVI) as a possible etiology or potentiator of multiple sclerosis has been recently proposed (e.g., Zamboni et al., J Neurol Neurosurg Psych 2009), and has sparked widespread public interest. For many reasons, MRI with MR venography may be a useful screening tool for CCSVI. Herein, we report our initial experience comparing MR and contrast venography in MS patients, specifically to determine venous stenoses and collateral flow.

METHOD AND MATERIALS

This retrospective study was approved by our IRB. MRI and contrast venograms performed within 1 day were reviewed in 42 MS patients (24 relapsing-remitting, 5 primary progressive, 13 secondary progressive) with a mean age 46 yrs (range 22-67 yrs). MR sequences evaluated included time-of-flight imaging and time-resolved contrast-enhanced angiography (TRICKS). Each internal jugular (IJ) vein was assessed at 3 locations (high [C1-2], mid [C3-5], and low [C6-T2]) using a 3 point scoring system (0=none, 1=mild, 2=moderate, 3=severe). The 6 scores in each patient (3 levels x 2 IJ’s) were summed to create a composite score, ranging from 0-18. Non-IJ collaterals were also graded from 0 to 3. Two radiologists scored the separate examinations in an independent and blinded manner. Measures of agreement, including Pearson’s correlation coefficient and paired two-tailed t-tests, were calculated.

RESULTS

Typical venous abnormalities were noted on both studies - most prominently, flattening of the IJ vessels near the C1 lateral masses and in the lower neck at the level of the sternocleidomastoid (Figure). The stenosis scores did not differ based on modality (MRI: 6.0±3.2; Contrast venogram: 6.5±3.6; p=0.36) and were correlated (R=0.62). While the correlation was good (R=0.44) for collaterals, MRI scores were significantly higher (MRI: 2.0±0.9; Contrast venography: 1.3±0.6; p<0.05).

CONCLUSION

MR and contrast venography compared well with each other, particularly for evaluating venous stenosis. While there is good correlation for collaterals, MR may overestimate their intensity. This framework may also permit assessment of possible differences in the cervical veins between MS patients and normal subjects.

CLINICAL RELEVANCE/APPLICATION

MR venography has been proposed as a potential screening tool for CCSVI, so we undertook to determine how well it compared with a more invasive, gold standard test, contrast venography.

Cite This Abstract

Zaharchuk, G, Dake, M, Cooke, J, Herfkens, R, Comparison of Magnetic Resonance Imaging and Contrast Venography in the Evaluation of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis Patients.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9013799.html