title: Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound--recommendations for a protocol.
abstract: Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses or obstructions of the internal jugular and/or azygos veins with disturbed flow and formation of collateral venous channels. Studies using ultrasound in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 70%; range 0-100%; N.=1496), whereas, in normal controls and patients without MS the prevalence was much lower (mean 10%; range 0-36%; N.=635). Ultrasound uses a combination of physiological measurements as well as anatomical imaging and has been used for the detection of CCSVI by different centers with variable results. A high prevalence ranging from 62% to 100% of obstructive lesions has been found by some teams in patients with MS compared with a lower prevalence of 0-25% in controls. However, absence of such lesions or a lower prevalence (16-52%) has been reported by others. This variability could be the result of differences in technique, training, experience or criteria used. The current lack of a methodology shared among experts is a confounding element in epidemiologic studies, and does not permit further Bayesan or other kind of analysis. In order to ensure a high reproducibility of Duplex scanning with comparable accuracy between centers, a detailed protocol with standard methodology and criteria is proposed. This is also necessary for training. It has been shown that inter-rater variability increases post-training (from k=0.47 to k=0.80), while within-rater reproducibility in trained operators was k=0.75. Finally, the consensus document proposes a reporting standard of Duplex measurements, and future research to answer areas of uncertainty.
authors.affiliation: Vascular Diseases Center, University of Ferrara, Ferrara, Italy. zmp@unife.it
authors.forename: P
authors.initials: P
authors.lastname: Zamboni
authors.forename: S
authors.initials: S
authors.lastname: Morovic
authors.forename: E
authors.initials: E
authors.lastname: Menegatti
authors.forename: G
authors.initials: G
authors.lastname: Viselner
authors.forename: A N
authors.initials: AN
authors.lastname: Nicolaides
mesh_terms: D001401:Azygos Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D002908:Chronic Disease; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D015588:Observer Variation; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D013116:Spinal Cord / Q000098:blood supply*; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex / Q000592:standards; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology