title: Chronic cerebrospinal venous insufficiency and venous stenoses in multiple sclerosis.
abstract: OBJECTIVE
  The traditional view that multiple sclerosis (MS) is an autoimmune disease has recently been challenged by the claim that MS is caused by chronic cerebrospinal venous insufficiency (CCSVI). Although several studies have questioned this vascular theory, the CCSVI controversy is still ongoing. Our aim was to assess the prevalence of CCSVI in Danish MS patients using sonography and compare these findings with MRI measures of venous flow and morphology.
  
  
  METHODS
  We investigated cervical and cerebral veins in 24 patients with relapsing-remitting MS (RRMS) and 15 healthy controls, using extracranial high-resolution ultrasound colour Doppler (US-CD) and transcranial colour Doppler sonography (TCDS), as well as magnetic resonance imaging (MRI) and phase-contrast MR blood flow measurements (PC-MR) of the cervical veins.
  
  
  RESULTS
  US-CD could not identify the left internal jugular vein (IJV) in one MS patient, other ultrasound examinations were normal in patients with MS. There was no difference in mean cross-sectional area of the IJV in MS patients compared with controls. Only one patient with MS and two healthy controls fulfilled one CCSVI criterion, and none fulfilled more than one CCSVI criterion. MR venography showed insignificant IJV stenosis (1-49%) in two patients with MS, whereas 50-69% IJV stenosis was detected in two healthy controls. There was no difference in PC-MR measurements of mean IJV blood flow between patients with MS and controls.
  
  
  CONCLUSIONS
  Our results do not corroborate the presence of vascular pathology in RRMS and we found no evidence supporting the CCSVI hypothesis.
authors.affiliation: Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Blink@dadlnet.dk
authors.forename: M
authors.initials: M
authors.lastname: Blinkenberg
authors.forename: P
authors.initials: P
authors.lastname: Akeson
authors.forename: H
authors.initials: H
authors.lastname: Sillesen
authors.forename: S
authors.initials: S
authors.lastname: Lövgaard
authors.forename: F
authors.initials: F
authors.lastname: Sellebjerg
authors.forename: O B
authors.initials: OB
authors.lastname: Paulson
authors.forename: H R
authors.initials: HR
authors.lastname: Siebner
authors.forename: P S
authors.initials: PS
authors.lastname: Sørensen
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply*; D017536:Carotid Artery, Common; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008279:Magnetic Resonance Imaging; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D015995:Prevalence; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D017585:Ultrasonography, Doppler, Transcranial; D014689:Venous Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*