title: Changes of cine cerebrospinal fluid dynamics in patients with multiple sclerosis treated with percutaneous transluminal angioplasty: a case-control study.
abstract: OBJECTIVE
  To investigate characteristics of cine phase contrast-calculated cerebrospinal fluid (CSF) flow and velocity measures in patients with relapsing-remitting (RR) multiple sclerosis (MS) receiving standard medical treatment who had been diagnosed with chronic cerebrospinal venous insufficiency (CCSVI) and underwent percutaneous transluminal angioplasty (PTA).
  
  
  METHODS
  This case-controlled, magnetic resonance (MR) imaging-blinded study included 15 patients with RR MS who presented with significant stenoses (≥50% lumen reduction on catheter venography) in the azygous or internal jugular veins. Eight patients underwent PTA in addition to medical therapy immediately following baseline assessments (case group) and seven had delayed PTA after 6 months of medical therapy alone (control group). CSF flow and velocity measures were quantified over 32 phases of the cardiac cycle by a semiautomated method. Outcomes were compared between groups at baseline and at 6 and 12 months of the study by mixed-effect model analysis.
  
  
  RESULTS
  At baseline, no significant differences in CSF flow or velocity measures were detected between groups. At month 6, significant improvement in flow (P<.001) and velocity (P = .013) outcomes were detected in the immediate versus the delayed group, and persisted to month 12 (P = .001 and P = .021, respectively). Within-group flow comparisons from baseline to follow-up showed a significant increase in the immediate group (P = .033) but a decrease in the delayed group (P = .024). Altered CSF flow and velocity measures were associated with worsening of clinical and MR outcomes in the delayed group.
  
  
  CONCLUSIONS
  PTA in patients with MS with CCSVI increased CSF flow and decreased CSF velocity, which are indicative of improved venous parenchyma drainage.
authors.affiliation: Buffalo Neuroimaging Analysis Center, University at Buffalo, Buffalo, NY 14203, USA. rzivadinov@bnac.net
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
authors.forename: Christopher
authors.initials: C
authors.lastname: Magnano
authors.forename: Roberto
authors.initials: R
authors.lastname: Galeotti
authors.forename: Claudiu
authors.initials: C
authors.lastname: Schirda
authors.forename: Erica
authors.initials: E
authors.lastname: Menegatti
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: Karen
authors.initials: K
authors.lastname: Marr
authors.forename: Ilaria
authors.initials: I
authors.lastname: Bartolomei
authors.forename: Jesper
authors.initials: J
authors.lastname: Hagemeier
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Malagoni
authors.forename: David
authors.initials: D
authors.lastname: Hojnacki
authors.forename: Cheryl
authors.initials: C
authors.lastname: Kennedy
authors.forename: Ellen
authors.initials: E
authors.lastname: Carl
authors.forename: Clive
authors.initials: C
authors.lastname: Beggs
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Salvi
authors.forename: Paolo
authors.initials: P
authors.lastname: Zamboni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000379:methods*; D016022:Case-Control Studies; D002550:Cerebral Veins / Q000473:pathology / Q000601:surgery*; D002555:Cerebrospinal Fluid / Q000166:cytology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D014741:Video Recording / Q000379:methods; D055815:Young Adult