title: CSF dynamics and brain volume in multiple sclerosis are associated with extracranial venous flow anomalies: a pilot study.
abstract: OBJECTIVE
  We previously reported unexpectedly robust associations between vascular haemodynamic (VH) anomalies in the principal extracranial cerebral veins, causing chronic cerebrospinal venous insufficiency (CCSVI), and multiple sclerosis (MS). Aim of this study was to investigate the relationship between the VH changes and MRI measures of MS disease severity in a cross sectional survey.
  
  
  METHODS
  The number of anomalous VH criteria were measured using an echo-color Doppler, whereas CSF flow, atrophy and lesion measures were obtained from quantitative magnetic resonance imaging (MRI) analysis in sixteen consecutive relapsing-remitting MS patients, (mean age: 36.1+/-SD 7.3 years, disease duration: 7.5+/-1.9 years and median EDSS: 2.5) and in 8 healthy controls (HC) with similar age and sex distributions.
  
  
  RESULTS
  All 16 MS patients investigated and none of the HCs met the VH criteria for CCSVI (P<0.0001). MS patients showed significantly lower net CSF flow compared to the HC (P=0.038) that was associated with number of anomalous VH criteria present (r=0.79, P<0.001). Moreover, increases in the number of anomalous VH criteria present were negatively associated with lower whole brain volume (Spearman R=-0.5, P=0.05).
  
  
  CONCLUSIONS
  VH changes occur more frequently in MS patients than controls. Altered VH is associated with abnormal CSF flow dynamics and decreased brain volume.
authors.affiliation: Vascular Diseases Center, University of Ferrara-Bellaria Neurosciences, Ferrara and Bologna, Italy. zmp@unife.it
authors.forename: P
authors.initials: P
authors.lastname: Zamboni
authors.forename: E
authors.initials: E
authors.lastname: Menegatti
authors.forename: B
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: C
authors.initials: C
authors.lastname: Schirda
authors.forename: J L
authors.initials: JL
authors.lastname: Cox
authors.forename: A M
authors.initials: AM
authors.lastname: Malagoni
authors.forename: D
authors.initials: D
authors.lastname: Hojnacki
authors.forename: C
authors.initials: C
authors.lastname: Kennedy
authors.forename: E
authors.initials: E
authors.lastname: Carl
authors.forename: M G
authors.initials: MG
authors.lastname: Dwyer
authors.forename: N
authors.initials: N
authors.lastname: Bergsland
authors.forename: R
authors.initials: R
authors.lastname: Galeotti
authors.forename: S
authors.initials: S
authors.lastname: Hussein
authors.forename: I
authors.initials: I
authors.lastname: Bartolomei
authors.forename: F
authors.initials: F
authors.lastname: Salvi
authors.forename: M
authors.initials: M
authors.lastname: Ramanathan
authors.forename: R
authors.initials: R
authors.lastname: Zivadinov
mesh_terms: D000328:Adult; D001284:Atrophy; D001401:Azygos Vein / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology; D001921:Brain / Q000473:pathology*; D002550:Cerebral Veins / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D003251:Constriction, Pathologic; D003430:Cross-Sectional Studies; D006801:Humans; D007601:Jugular Veins / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000503:physiopathology; D009929:Organ Size; D010865:Pilot Projects; D012039:Regional Blood Flow; D013116:Spinal Cord / Q000098:blood supply*; D018615:Ultrasonography, Doppler, Color; D014689:Venous Insufficiency / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000503:physiopathology