title: No evidence for impairment of venous hemodynamics in children or young adults with pediatric-onset multiple sclerosis.
abstract: OBJECTIVE
  Chronic cerebrospinal venous insufficiency is a postulated etiologic factor for multiple sclerosis, but the higher frequency with longer disease duration and progressive disability suggests that chronic cerebrospinal venous insufficiency is secondary to chronic disease. We evaluated the presence of chronic cerebrospinal venous insufficiency in pediatric-onset MS.
  
  
  METHODS
  Twenty-six pediatric patients with MS (18 years of age or younger), 26 age-matched healthy controls, and 13 young adults with pediatric-onset MS underwent sonography of the internal jugular, vertebral, and deep cerebral veins. Five venous hemodynamic criteria were assessed, with 2 criteria required for chronic cerebrospinal venous insufficiency. MR imaging studies, performed in the pediatric patients with MS and healthy control groups, included intracranial 2D time-of-flight MR venography and velocity-sensitive phase-contrast sequences. Contrast-enhanced brain MR images were obtained in pediatric patients with MS to further evaluate venous patency. We used paired t tests, Wilcoxon matched pairs, McNemar tests, and exact conditional logistic regression to estimate the association of chronic cerebrospinal venous insufficiency with MS.
  
  
  RESULTS
  Fifty participants (73.5%) had normal ultrasound findings, 15 (23.1%) met 1 venous hemodynamic criterion, and 2 pediatric patients with MS and 1 young adult with pediatric-onset MS met chronic cerebrospinal venous insufficiency criteria. Chronic cerebrospinal venous insufficiency was not associated with MS (odds ratio, 2.41; 95% CI, 0.19-infinity). Demographic and disease characteristics did not differ between the patients with MS meeting chronic cerebrospinal venous insufficiency criteria (n = 3) and those who did not (n = 36; all, P > .05). The mean (SD) MR imaging measures of intracerebral flow did not differ between the 2 pediatric patients with MS meeting chronic cerebrospinal venous insufficiency criteria (0.85 ± 0.11) and healthy controls (0.87 ± 0.16, P = .50); no child demonstrated venous obstruction.
  
  
  CONCLUSIONS
  Chronic cerebrospinal venous insufficiency is rarely observed in children or young adults with pediatric-onset MS. Venous anatomy and flow rates indicate that venous outflow is intact in pediatric patients with MS. Our findings argue against chronic cerebrospinal venous insufficiency as a component of MS etiology.
authors.affiliation: Departments of Diagnostic Imaging.
authors.forename: S
authors.initials: S
authors.lastname: Laughlin
authors.forename: C K
authors.initials: CK
authors.lastname: Macgowan
authors.forename: J
authors.initials: J
authors.lastname: Traubici
authors.forename: K
authors.initials: K
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Khan
authors.forename: D L
authors.initials: DL
authors.lastname: Arnold
authors.forename: R A
authors.initials: RA
authors.lastname: Marrie
authors.forename: B
authors.initials: B
authors.lastname: Banwell
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography; D008297:Male; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D018570:Risk Assessment; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography; D014689:Venous Insufficiency / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult