title: Use of MR venography for characterization of the extracranial venous system in patients with multiple sclerosis and healthy control subjects.
abstract: OBJECTIVE
  To investigate the differences in the extracranial venous system in patients with multiple sclerosis (MS) and healthy control (HC) subjects by using magnetic resonance (MR) venography.
  
  
  METHODS
  This HIPAA-compliant, prospective study was approved by the local institutional review board, and all participants gave informed consent. Fifty-seven patients, 41 (72%) with relapsing-remitting MS and 16 (28%) with secondary-progressive MS, and 21 HC subjects were imaged with a 3-T MR unit by using two-dimensional (2D) time-of-flight (TOF) and three-dimensional (3D) time-resolved imaging of contrast kinetics (TRICKS) sequences. In addition, six MS patients and six HC subjects underwent two sequential MR venographic examinations during 1 week to test image-reimage reproducibility. The morphologic features of internal jugular vein flow were classified as absent, pinpoint, flattened, crescentic, or ellipsoidal flow. Only absent and pinpoint flow were considered abnormal. The flow of the vertebral veins was classified as absent or present. The prominence of collateral neck veins and venous asymmetries between the left and right sides were assessed. Differences among groups were tested with a two-tailed Mann-Whitney two-sample rank-sum test.
  
  
  RESULTS
  No significant differences in morphologic features of flow in the internal jugular veins and vertebral veins were found between MS patients and HC subjects in any of the examined MR venographic parameters. No differences in asymmetry or prominence were found between MS patients and HC subjects. There was modest agreement (κ = 0.67) between 2D TOF and 3D TRICKS sequences. Image-reimage reproducibility showed modest agreement (κ = 0.66) for 2D TOF and low agreement for 3D TRICKS (κ = 0.33).
  
  
  CONCLUSIONS
  No significant differences in the extracranial venous systems between MS patients and HC subjects were detected by using MR venography. Standardized guidelines are needed to define parameters for the presence of venous anomalies.
authors.affiliation: Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, State University of New York, 100 High St, Buffalo, NY 14203, USA. rzivadinov@bnac.net
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lopez-Soriano
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: Claudiu V
authors.initials: CV
authors.lastname: Schirda
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Magnano
authors.forename: Kresimir
authors.initials: K
authors.lastname: Dolic
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Kennedy
authors.forename: Christina L
authors.initials: CL
authors.lastname: Brooks
authors.forename: Justine A
authors.initials: JA
authors.lastname: Reuther
authors.forename: Kristin
authors.initials: K
authors.lastname: Hunt
authors.forename: Michelle
authors.initials: M
authors.lastname: Andrews
authors.forename: Michael G
authors.initials: MG
authors.lastname: Dwyer
authors.forename: David W
authors.initials: DW
authors.lastname: Hojnacki
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003287:Contrast Media; D005145:Face / Q000098:blood supply*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D021621:Imaging, Three-Dimensional; D007601:Jugular Veins / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications* / Q000503:physiopathology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000503:physiopathology; D009333:Neck / Q000098:blood supply*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA