Systematic review of sonographic chronic cerebrospinal venous insufficiency findings in multiple sclerosis.
OBJECTIVE
The sonographic findings of chronic cerebrospinal venous insufficiency (CCSVI) are used by some as selection criteria for venography. We performed a systematic review to establish the prevalence and strength of association between sonographic CCSVI and multiple sclerosis (MS).


METHODS
Two reviewers searched PubMed and EMBASE from 1948 to date using the keywords 'chronic cerebrospinal venous insufficiency' according to PRISMA guidelines.


RESULTS
Four cross-sectional studies met the criteria for inclusion. The prevalence of CCSVI ranged from 7% to 100% in MS patients and from 2% to 36% in healthy controls. Diagnostic odds ratios for MS varied between 2 and 26, 499 (I(2) = 94%). Sensitivities of CCSVI for MS varied between 7% and 100% (I(2) = 98%). Specificities varied between 64% and 100% (I(2) = 95%).


CONCLUSIONS
There is substantial variation in the strength of association between CCSVI and MS beyond that explained by demographic differences or sonographer training. Reliable evidence on which to base decisions requires sonographic consensus and assessment of the reproducibility of individual criteria between trained sonographers.
Imperial College London, London UK. a.thapar09@imperial.ac.uk
A
A
Thapar
T
T
Lane
R
R
Nicholas
T
T
Friede
M
M
Ellis
J
J
Assenheim
I J
IJ
Franklin
A H
AH
Davies
D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D039781:PubMed; D013131:Spine / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D014463:Ultrasonography; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology