title: Chronic cerebrospinal venous insufficiency: masked multimodal imaging assessment.
abstract: BACKGROUND
  Chronic cerebrospinal venous insufficiency (CCSVI) was implicated in the pathophysiology of multiple sclerosis (MS).
  
  
  OBJECTIVE
  We evaluated neurosonography (NS), magnetic resonance venography (MRV), and transluminal venography (TLV) in subsets of MS patients drawn from a single-center, prospective, case-control study of 206 MS and 70 non-MS volunteers.
  
  
  METHODS
  As previously reported, findings on high-resolution B-mode NS imaging with color and spectral Doppler of the extracranial and intracranial venous drainage consistent with CCSVI were similar among MS and non-MS volunteers (3.88% vs 7.14%; p = 0.266). Ninety-nine MS participants consented to intravascular contrast-enhanced 3D MRV to assess their major systemic and intracranial venous circulation, and 40 advanced to TLV that included pressure measurements of the superior vena cava, internal jugular, brachiocephalic, and azygous veins.
  
  
  RESULTS
  NS findings and MRV patterns were discrepant for 26/98 evaluable subjects, including four with abnormal findings on NS that had normal venous anatomy by MRV. In no instance were TLV pressure gradients indicative of clinically significant functional stenosis encountered. The three imaging approaches provided generally consistent data with discrepancies referable to inherent technique properties.
  
  
  CONCLUSIONS
  Our findings lend no support for altered venous outflow dynamics as common among MS patients, nor do they likely contribute to the disease process.
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, USA.
authors.forename: Staley A
authors.initials: SA
authors.lastname: Brod
authors.forename: Larry A
authors.initials: LA
authors.lastname: Kramer
authors.forename: Alan M
authors.initials: AM
authors.lastname: Cohen
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Barreto
authors.forename: Thanh-Tung
authors.initials: TT
authors.lastname: Bui
authors.forename: James R
authors.initials: JR
authors.lastname: Jemelka
authors.forename: Kelly
authors.initials: K
authors.lastname: Ton
authors.forename: John W
authors.initials: JW
authors.lastname: Lindsey
authors.forename: Flavia
authors.initials: F
authors.lastname: Nelson
authors.forename: Ponnada A
authors.initials: PA
authors.lastname: Narayana
authors.forename: Jerry S
authors.initials: JS
authors.lastname: Wolinsky
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009103:Multiple Sclerosis / Q000150:complications / Q000209:etiology / Q000473:pathology*; D010690:Phlebography / Q000379:methods; D013116:Spinal Cord / Q000098:blood supply*; D018608:Ultrasonography, Doppler / Q000379:methods; D014689:Venous Insufficiency / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*
keywords: Multiple sclerosis; cerebral venous outflow; chronic cerebrospinal venous insufficiency; magnetic resonance venography; neurosonography; venography