Carlos Hernando Torres MD, Presenter: Nothing to Disclose

Cheemun Lum MD, Abstract Co-Author: Nothing to Disclose

Santanu Chakraborty FRCR, DMRD, Abstract Co-Author: Speakers Bureau, Merck KGaA Speakers Bureau, Novartis AG Grant, Bayer AG

Thanh Nguyen MD, Abstract Co-Author: Research Grant, Bayer AG Research Consultant, Bayer AG

Betty Anne Schwarz MSc, RN, Abstract Co-Author: Nothing to Disclose

Stefanie Belanger, Abstract Co-Author: Nothing to Disclose

Lysa Legault-Kingstone, Abstract Co-Author: Nothing to Disclose

Mark Freedman, Abstract Co-Author: Nothing to Disclose

Hamid Reza Dabirzadeh MD, Abstract Co-Author: Nothing to Disclose

Miguel Bussiere, Abstract Co-Author: Nothing to Disclose

Ian Cameron, Abstract Co-Author: Nothing to Disclose

Rebecca Thornhill, Abstract Co-Author: Nothing to Disclose

Matthew J Hogan MD, Abstract Co-Author: Nothing to Disclose

Zamboni et al suggest that multiple sclerosis (MS) may develop secondarily to impaired central nervous system venous outflow and describes this as Chronic Cerebrospinal Venous Insufficiency (CCSVI). Internal jugular vein (IJV) stenosis is suggested as a cause. This study assesses the prevalence of IJV stenosis in patients with multiple sclerosis and age matched controls using contrast enhanced MR venography (CE-MRV). Potential correlation of IJV stenosis with CCSVI defined by Doppler ultrasound (US) is evaluated.

This was a single-center, prospective, observational study of 50 subjects with a confirmed diagnosis of multiple sclerosis with age-matched controls. Research ethics approval and informed consent were obtained. Subjects were randomly selected from 6 MS categories. CE-MRV was performed on a 3T magnet. US evaluation of the intra and extracranial circulation was used to define CCSVI criteria. Imaging results were reviewed independently by pairs of neuroradiologists blind to subject assignment. From MRV images the degree of stenosis was graded within the lower, mid and upper 1/3 segments of the IJV. US evaluation was considered positive if 2 or more CCSVI criteria were present.

100 studies were undertaken. 13 could not be evaluated due to poor MRV quality.  Inter-observer variability for IJV stenosis was fair for lower 1/3 (ICC 0.45 (0.24-0.61)), poor for mid 1/3 (ICC 0.18 (-0.03-0.38)) and good for upper 1/3 (ICC 0.71 (0.58-0.80)) IJV segments. IJV stenosis was identified in 85 (98%) of subjects. Stenosis >= 50% was identified in 31 (70%) of patients and 32 (74%) of controls and was more probable in both groups in the upper 1/3 IJV segment. Stenosis of the lower 1/3 IJV segment was more frequently observed in patients (p=0.01, RANOVA). A positive CCSVI score was identified in 12 patients and no controls (p < 0.001, Fisher’s exact test). For positive CCSVI there was a greater proportion of IJV stenosis >= 50 but only in the lower 1/3 IJV segment (p < 0.001) where a weak correlation (Spearman-Rank – 0.4, p <0.001) exists between CCSVI score and stenosis.  

IJV stenosis is highly prevalent on MRV and does not distinguish between MS and control subjects. A weak correlation exists between lower 1/3 segment IJV stenosis and CCSVI criteria.

IJV stenosis is not strongly associated with MS and cannot be considered a causative factor in this disease.  

Torres, C, Lum, C, Chakraborty, S, Nguyen, T, Schwarz, B, Belanger, S, Legault-Kingstone, L, Freedman, M, Dabirzadeh, H, Bussiere, M, Cameron, I, Thornhill, R, Hogan, M, Contrast-enhanced MR Venography in Patients with Multiple Sclerosis to Assess Stenoses of the Internal Jugular Veins—Is there Correlation with CCSVI Criteria?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045718.html