title: Neck duplex Doppler ultrasound evaluation for assessing chronic cerebrospinal venous insufficiency in multiple sclerosis patients.
abstract: BACKGROUND
  Recent clinical studies have suggested a relationship between multiple sclerosis (MS) and the occurrence of pathological changes in the jugular, vertebral and azygous veins that result in abnormal blood outflow from the brain and the spinal cord. Together, these pathological changes have been designated chronic cerebrospinal venous insufficiency (CCSVI). The aim of the present study was to evaluate the usefulness of duplex Doppler ultrasound in the evaluation of central nervous system venous outflow disturbances in patients suffering from MS.
  
  
  METHODS
  We examined 181 patients with MS, diagnosed on the basis of the McDonald criteria, and 50 healthy volunteer controls. All patients underwent Doppler ultrasound examination of the internal jugular veins (IJV) and vertebral veins (VVs). The presence of outflow disturbances and morphological abnormalities were evaluated.
  
  
  RESULTS
  Pathological changes in the extracranial jugular veins were diagnosed in 148/181 MS patients (82%) and 7/50 control group volunteers (14%). The following abnormalities in the MS group were revealed: the presence of a reflux in the IJVs and/or VVs (54%), narrowing (54%), a complete block in the flow through the IJV (10%) and an abnormal postural control of the cerebral outflow route (25%). These particular pathologies were of statistical significance in the MS group compared with the control group. This study also revealed a correlation between the occurrence of inverted flow in patients in a sitting position and chronic progressive MS (P = 0.0033).
  
  
  CONCLUSIONS
  The examinations undertaken indicate a possible connection between MS and CCSVI. The widely accessible and highly sensitive and specific Doppler ultrasound test may be useful for revealing, and preliminary analysis of, CCSVI pathologies.
authors.affiliation: Department of Surgery, Medical University of Silesia, District Specialist Hospital, Tychy, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Zaniewski
authors.forename: J
authors.initials: J
authors.lastname: Kostecki
authors.forename: W
authors.initials: W
authors.lastname: Kuczmik
authors.forename: D
authors.initials: D
authors.lastname: Ziaja
authors.forename: G
authors.initials: G
authors.lastname: Opala
authors.forename: M
authors.initials: M
authors.lastname: Świat
authors.forename: T
authors.initials: T
authors.lastname: Korzeniowski
authors.forename: E
authors.initials: E
authors.lastname: Majewski
authors.forename: T
authors.initials: T
authors.lastname: Urbanek
authors.forename: K
authors.initials: K
authors.lastname: Pawlicki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009333:Neck / Q000098:blood supply*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D013131:Spine / Q000098:blood supply*; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D018617:Ultrasonography, Doppler, Pulsed; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055815:Young Adult