title: Four-dimensional flow magnetic resonance imaging and ultrasound assessment of cerebrospinal venous flow in multiple sclerosis patients and controls.
abstract: A possibly causal relationship between multiple sclerosis and chronic cerebrospinal venous insufficiency has recently been hypothesized. Studies investigating chronic cerebrospinal venous insufficiency have reported conflicting results and few have employed multiple diagnostic imaging modalities across a large patient and control population. In this study, three complementary imaging modalities were used to investigate the chronic cerebrospinal venous insufficiency hypothesis in patients with multiple sclerosis and two age- and sex-matched control groups: healthy volunteers and patients with other neurological diseases. Strictly blinded Doppler ultrasound according to the original chronic cerebrospinal venous insufficiency hypothesis; four-dimensional flow magnetic resonance imaging of venous flow in the head, neck, and chest; and contrast-enhanced magnetic resonance venography for neck and chest venous luminography were acquired. An internal jugular vein stenosis evaluation was also performed across modalities. Percentage of subjects meeting ultrasound-based chronic cerebrospinal venous insufficiency criteria was small and similar between groups. In group-wise and pairwise testing, no four-dimensional flow magnetic resonance imaging variables were statistically significantly different, for any measurement location. In contrast-enhanced magnetic resonance venography of the internal jugular and azygos veins, no statistically significant differences were observed in stenosis scores between groups. These results represent compelling evidence against the chronic cerebrospinal venous insufficiency hypothesis in multiple sclerosis.
authors.affiliation: 1 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Schrauben
authors.affiliation: 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kohn
authors.affiliation: 3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Macdonald
authors.affiliation: 3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Johnson
authors.affiliation: 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Kliewer
authors.affiliation: 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Frost
authors.affiliation: 4 Department of Neurology, University of Wisconsin-Madison, Madison, USA.
authors.forename: John O
authors.initials: JO
authors.lastname: Fleming
authors.affiliation: 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.|3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Wieben
authors.affiliation: 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.|5 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Field
mesh_terms: D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003430:Cross-Sectional Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018608:Ultrasonography, Doppler / Q000379:methods*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Doppler ultrasound; four-dimensional flow magnetic resonance imaging; multiple sclerosis; venous blood flow; venous luminography