title: Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS.
abstract: BACKGROUND
  Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in patients with multiple sclerosis (MS). A subject is considered CCSVI positive if ≥ 2 venous hemodynamic (VH) criteria are fulfilled.
  
  
  OBJECTIVE
  To determine prevalence of CCSVI in a large cohort of patients with MS, clinically isolated syndrome (CIS), other neurologic diseases (OND), and healthy controls (HC), using specific proposed echo-color Doppler (ECD) criteria.
  
  
  METHODS
  Transcranial and extracranial ECD were carried out in 499 enrolled subjects (289 MS, 163 HC, 26 OND, 21 CIS). Prevalence rates for CCSVI were calculated in 3 ways: first, using only the subjects for whom diagnosis was certain (i.e., borderline subjects were excluded); secondly, including the borderline subjects in the "no CCSVI" group; and finally, taking into account subjects who presented any of the VH criteria.
  
  
  RESULTS
  CCSVI prevalence with borderline cases included in the "no CCSVI" group was 56.1% in MS, 42.3% in OND, 38.1% in CIS, and 22.7% in HC (p < 0.001). The CCSVI prevalence figures were 62.5% for MS, 45.8% for OND, 42.1% for CIS, and 25.5% for HC when borderline cases were excluded (p < 0.001). The prevalence of one or more positive VH criteria was the highest in MS (81.3%), followed by CIS (76.2%), OND (65.4%), and HC (55.2%) (p < 0.001). CCSVI prevalence was higher in patients with progressive than in nonprogressive MS (p = 0.004).
  
  
  CONCLUSIONS
  Our findings are consistent with an increased prevalence of CCSVI in MS but with modest sensitivity/specificity. Our findings point against CCSVI having a primary causative role in the development of MS.
authors.affiliation: Department of Neurology, School of Medicine and Biomedical Sciences Buffalo Neuroimaging Analysis Center, Buffalo, NY 14203, USA. rzivadinov@bnac.net
authors.forename: R
authors.initials: R
authors.lastname: Zivadinov
authors.forename: K
authors.initials: K
authors.lastname: Marr
authors.forename: G
authors.initials: G
authors.lastname: Cutter
authors.forename: M
authors.initials: M
authors.lastname: Ramanathan
authors.forename: R H B
authors.initials: RH
authors.lastname: Benedict
authors.forename: C
authors.initials: C
authors.lastname: Kennedy
authors.forename: M
authors.initials: M
authors.lastname: Elfadil
authors.forename: A E
authors.initials: AE
authors.lastname: Yeh
authors.forename: J
authors.initials: J
authors.lastname: Reuther
authors.forename: C
authors.initials: C
authors.lastname: Brooks
authors.forename: K
authors.initials: K
authors.lastname: Hunt
authors.forename: M
authors.initials: M
authors.lastname: Andrews
authors.forename: E
authors.initials: E
authors.lastname: Carl
authors.forename: M G
authors.initials: MG
authors.lastname: Dwyer
authors.forename: D
authors.initials: D
authors.lastname: Hojnacki
authors.forename: B
authors.initials: B
authors.lastname: Weinstock-Guttman
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D015995:Prevalence; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D014689:Venous Insufficiency / Q000175:diagnosis / Q000453:epidemiology*