title: Validity of the diagnostic criteria for chronic cerebrospinal venous insufficiency and association with multiple sclerosis.
abstract: BACKGROUND
  The chronic cerebrospinal venous insufficiency theory proposes that altered cerebral venous hemodynamics play a role in the pathophysiology of multiple sclerosis. We aimed to explore the validity of this hypothesis by assessing the diagnostic criteria for chronic cerebrospinal venous insufficiency in persons with and without multiple sclerosis.
  
  
  METHODS
  We compared the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls using extracranial Doppler ultrasonography and gadolinium-enhanced magnetic resonance venography. Interpreting radiologists were blinded to the clinical status of participants.
  
  
  RESULTS
  We enrolled 120 patients with multiple sclerosis and 60 healthy controls. High proportions of both patients (67/115 [58%]) and controls (38/60 [63%]) met 1 or more of the proposed ultrasound criteria for diagnosis of chronic cerebrospinal venous insufficiency (p = 0.6). A minority of patients (23/115 [20%]) and controls (6/60 [10%]) fulfilled 2 or more of the proposed criteria (p = 0.1). There were no differences between patients and controls in the prevalence of each individual ultrasound criterion. Similarly, there were no differences in intracranial or extracranial venous patency between groups, as measured by magnetic resonance venography.
  
  
  CONCLUSIONS
  We detected no differences in the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls. Moreover, our study revealed significant methodologic concerns regarding the proposed diagnostic criteria for chronic cerebrospinal venous insufficiency that challenge their validity.
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta. Vonacostello@rogers.com.
authors.forename: Fiona
authors.initials: F
authors.lastname: Costello
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: Jayesh
authors.initials: J
authors.lastname: Modi
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: David
authors.initials: D
authors.lastname: Lautner
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bhayana
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: James N
authors.initials: JN
authors.lastname: Scott
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: W Jeptha
authors.initials: WJ
authors.lastname: Davenport
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: Jessie
authors.initials: J
authors.lastname: Trufyn
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: Richard
authors.initials: R
authors.lastname: Frayne
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: Viesha A
authors.initials: VA
authors.lastname: Ciura
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: Jean
authors.initials: J
authors.lastname: Mah
authors.affiliation: Departments of Clinical Neurosciences (Costello, Modi, Scott, Davenport, Trufyn, Frayne, Ciura, Goyal, Hill), Surgery (Costello), Radiology (Modi, Lautner, Bhayana, Scott, Frayne, Ciura, Goyal), Pediatrics (Mah), Medical Genetics (Davenport), Medicine (Hill) and Community Health Sciences (Hill); Hotchkiss Brain Institute (Costello, Davenport, Hill); and Seaman Family Centre, Foothills Medical Centre, Alberta Health Services (Bhayana, Scott, Frayne, Goyal), University of Calgary, Calgary, Alta.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply*; D016022:Case-Control Studies; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000209:etiology*; D011446:Prospective Studies; D016037:Single-Blind Method; D013116:Spinal Cord / Q000098:blood supply*; D018615:Ultrasonography, Doppler, Color; D014689:Venous Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology