title: A sonographic quantitative cutoff value of cerebral venous outflow in neurologic diseases: a blinded study of 115 subjects.
abstract: OBJECTIVE
  The autonomic nervous system maintains constant cerebral venous blood outflow in changing positions. Alterations in cerebral autoregulation can be revealed by postural changes at quantitative color Doppler sonography. The aim of this study was to reach an optimal cutoff value of the difference between the cerebral venous blood outflow in the supine and seated positions that can discriminate healthy controls from patients with multiple sclerosis and those with other neurologic diseases and to evaluate its specificity, sensitivity, and diagnostic accuracy.
  
  
  METHODS
  One hundred fifteen subjects (54 with MS, 31 healthy controls, 30 with other neurologic diseases) underwent a blinded quantitative color Doppler sonography evaluation of cerebral venous blood outflow in the supine and sitting positions. An optimal difference value between the supine and sitting positions of the cerebral venous blood outflow cutoff value was sought.
  
  
  RESULTS
  The difference value between supine and sitting positions of the cerebral venous blood outflow was ≤ 503.24 in 38/54 (70.37%) patients with MS, 9/31 (29.03%) healthy controls, and 13/30 (43.33%) subjects with other neurological diseases. A difference value between supine and sitting positions of the cerebral venous blood outflow at a 503.24 cutoff reached a sensitivity at 70.37%, a 70.96% specificity, a 80.85% positive predictive value, and a 57.89% negative predictive value; the quantitative color Doppler sonography parameters yielded significant differences. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 assessed the significant difference between MS versus other neurological diseases.
  
  
  CONCLUSIONS
  Alteration of cerebral venous blood outflow discriminated MS versus other neurologic diseases and MS versus healthy controls. The difference value between supine and sitting positions of cerebral venous blood outflow ≤ 503.24 was statistically associated with MS.
authors.affiliation: From the Unit of Neuroimaging and Neurointervention (L.M., E.M., S.L., U.A., M.B., A.Z., P.G.), Department of Neurological and Sensorial Sciences, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy l.monti@ao-siena.toscana.it.
authors.forename: L
authors.initials: L
authors.lastname: Monti
authors.affiliation: From the Unit of Neuroimaging and Neurointervention (L.M., E.M., S.L., U.A., M.B., A.Z., P.G.), Department of Neurological and Sensorial Sciences, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Menci
authors.affiliation: Department of Medicine, Surgery and Neuroscience (P.P.), University of Siena, Siena, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Piu
authors.affiliation: From the Unit of Neuroimaging and Neurointervention (L.M., E.M., S.L., U.A., M.B., A.Z., P.G.), Department of Neurological and Sensorial Sciences, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Leonini
authors.affiliation: From the Unit of Neuroimaging and Neurointervention (L.M., E.M., S.L., U.A., M.B., A.Z., P.G.), Department of Neurological and Sensorial Sciences, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Arrigucci
authors.affiliation: From the Unit of Neuroimaging and Neurointervention (L.M., E.M., S.L., U.A., M.B., A.Z., P.G.), Department of Neurological and Sensorial Sciences, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bellini
authors.affiliation: From the Unit of Neuroimaging and Neurointervention (L.M., E.M., S.L., U.A., M.B., A.Z., P.G.), Department of Neurological and Sensorial Sciences, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Zandonella
authors.affiliation: From the Unit of Neuroimaging and Neurointervention (L.M., E.M., S.L., U.A., M.B., A.Z., P.G.), Department of Neurological and Sensorial Sciences, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Galluzzi
authors.affiliation: Unit of Endovascular and Percutaneous Therapy (A.C.), Clinica Nuestra Señora del Rosario, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Casasco
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004453:Echoencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D056888:Patient Positioning / Q000379:methods*; D011187:Posture; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method