Fiona Costello1, Jayesh Modi2, David Lautner2, Deepak Bhayana2, James N Scott2, W Jeptha Davenport2, Jessie Trufyn2, Richard Frayne2, Viesha A Ciura2, Mayank Goyal2, Jean Mah2, Michael D Hill2. 1. Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta. Vonacostello@rogers.com. 2. Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
Abstract
BACKGROUND: The chronic cerebrospinal venous insufficiency theory proposes that altered cerebral venous hemodynamics play a role in the pathophysiology of multiple sclerosis. We aimed to explore the validity of this hypothesis by assessing the diagnostic criteria for chronic cerebrospinal venous insufficiency in persons with and without multiple sclerosis. METHODS: We compared the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls using extracranial Doppler ultrasonography and gadolinium-enhanced magnetic resonance venography. Interpreting radiologists were blinded to the clinical status of participants. RESULTS: We enrolled 120 patients with multiple sclerosis and 60 healthy controls. High proportions of both patients (67/115 [58%]) and controls (38/60 [63%]) met 1 or more of the proposed ultrasound criteria for diagnosis of chronic cerebrospinal venous insufficiency (p = 0.6). A minority of patients (23/115 [20%]) and controls (6/60 [10%]) fulfilled 2 or more of the proposed criteria (p = 0.1). There were no differences between patients and controls in the prevalence of each individual ultrasound criterion. Similarly, there were no differences in intracranial or extracranial venous patency between groups, as measured by magnetic resonance venography. INTERPRETATION: We detected no differences in the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls. Moreover, our study revealed significant methodologic concerns regarding the proposed diagnostic criteria for chronic cerebrospinal venous insufficiency that challenge their validity.
BACKGROUND: The chronic cerebrospinal venous insufficiency theory proposes that altered cerebral venous hemodynamics play a role in the pathophysiology of multiple sclerosis. We aimed to explore the validity of this hypothesis by assessing the diagnostic criteria for chronic cerebrospinal venous insufficiency in persons with and without multiple sclerosis. METHODS: We compared the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls using extracranial Doppler ultrasonography and gadolinium-enhanced magnetic resonance venography. Interpreting radiologists were blinded to the clinical status of participants. RESULTS: We enrolled 120 patients with multiple sclerosis and 60 healthy controls. High proportions of both patients (67/115 [58%]) and controls (38/60 [63%]) met 1 or more of the proposed ultrasound criteria for diagnosis of chronic cerebrospinal venous insufficiency (p = 0.6). A minority of patients (23/115 [20%]) and controls (6/60 [10%]) fulfilled 2 or more of the proposed criteria (p = 0.1). There were no differences between patients and controls in the prevalence of each individual ultrasound criterion. Similarly, there were no differences in intracranial or extracranial venous patency between groups, as measured by magnetic resonance venography. INTERPRETATION: We detected no differences in the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls. Moreover, our study revealed significant methodologic concerns regarding the proposed diagnostic criteria for chronic cerebrospinal venous insufficiency that challenge their validity.
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