title: Sensitivity and specificity for screening of chronic cerebrospinal venous insufficiency using a multimodal non-invasive imaging approach in patients with multiple sclerosis.
abstract: The aim of this study was to investigate whether a combination of Doppler sonography (DS) and magnetic resonance venography (MRV) on 3T MRI increases specificity for detection of chronic cerebrospinal venous insufficiency (CCSVI) in 171 (113 relapsing-remitting, 47 secondary-progressive, 11 primary progressive) patients with multiple sclerosis (MS) and 79 age- and sex matched healthy controls (HCs). One hundred ten (64.3%) MS patients and 30 (38%) HCs presented ≥2 venous hemodynamic CCSVI criteria (p<.0001). Both DS and MRV showed relatively high specificity but lower sensitivity for determining a CCSVI diagnosis in patients with MS vs HCs and between MS subgroups. In MS patients this diagnostic specificity increased to over 90% by combining internal jugular vein and vertebral vein abnormal DS and MRV findings, reflux in deep cerebral veins and MRV findings of >1 collateral veins. This study suggests that a multimodal non-invasive approach (DS and MRV) increases the specificity for a diagnosis of CCSVI in patients with MS.
authors.affiliation: Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, NY 14203, USA.
authors.forename: K
authors.initials: K
authors.lastname: Dolic
authors.forename: K
authors.initials: K
authors.lastname: Marr
authors.forename: V
authors.initials: V
authors.lastname: Valnarov
authors.forename: M G
authors.initials: MG
authors.lastname: Dwyer
authors.forename: E
authors.initials: E
authors.lastname: Carl
authors.forename: J
authors.initials: J
authors.lastname: Hagemeier
authors.forename: C
authors.initials: C
authors.lastname: Kennedy
authors.forename: C
authors.initials: C
authors.lastname: Brooks
authors.forename: C
authors.initials: C
authors.lastname: Kilanowski
authors.forename: K
authors.initials: K
authors.lastname: Hunt
authors.forename: D
authors.initials: D
authors.lastname: Hojnacki
authors.forename: B
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: R
authors.initials: R
authors.lastname: Zivadinov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods / Q000592:standards; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards*; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications*; D010690:Phlebography / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods / Q000592:standards; D014689:Venous Insufficiency / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult