title: Prevalence of Extracranial Venous Narrowing on Magnetic Resonance Venography Is Similar in People With Multiple Sclerosis, Their Siblings, and Unrelated Healthy Controls: A Blinded, Case-Control Study.
abstract: OBJECTIVE
  The study sought to assess and compare the prevalence of narrowing of the major extracranial veins in subjects with multiple sclerosis and controls, and to assess the sensitivity and specificity of magnetic resonance venography (MRV) for describing extracranial venous narrowing as it applies to the chronic cerebrospinal venous insufficiency theory, using catheter venography (CV) as the gold standard.
  
  
  METHODS
  The jugular and azygos veins were assessed with time-of-flight MRV in this assessor-blinded, case-control study of subjects with multiple sclerosis, their unaffected siblings, and unrelated controls. The veins were evaluated by diameter and area, and compared with CV. Collateral vessels were also analyzed for maximal diameter, as a potential indicator of compensatory flow.
  
  
  RESULTS
  A high prevalence of extracranial venous narrowing was demonstrated in all study groups, collectively up to 84% by diameter criteria and 90% by area, with no significant difference between the groups when assessed independently (P = .34 and .63, respectively). There was high interobserver variability in the reporting of vessel narrowing (kappa = 0.32), and poor vessel per vessel correlation between narrowing on MRV and CV (kappa = 0.064). Collateral neck veins demonstrated no convincing difference in maximum size or correlation with jugular narrowing.
  
  
  CONCLUSIONS
  There is a high prevalence of narrowing of the major extracranial veins on MRV in all 3 study groups, with no significant difference between them. These findings do not support the chronic cerebrospinal venous insufficiency theory. Although MRV has shown a high sensitivity for identifying venous narrowing, time-of-flight imaging demonstrates poor interobserver agreement and poor specificity when compared with the gold standard CV.
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: nmtmartin@gmail.com.
authors.forename: Nancy
authors.initials: N
authors.lastname: Martin
authors.affiliation: Department of Medicine (Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Traboulsee
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Machan
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Klass
authors.affiliation: Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Tasha
authors.initials: T
authors.lastname: Ellchuk
authors.affiliation: Department of Medicine (Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Yinshan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Knox
authors.affiliation: Department of Surgery, College of Medicine, University of Saskatchewan and Regina Qu'Appelle Health Region (Section of Vascular Surgery), Regina, Saskatchewan, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Kopriva
authors.affiliation: Department of Medical Imaging, College of Medicine, University of Saskatchewan and Regina Qu-Appelle Health Region, Regina, Saskatchewan, Canada.
authors.forename: Shantilal
authors.initials: S
authors.lastname: Lala
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Nickel
authors.affiliation: Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Otani
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Warren R
authors.initials: WR
authors.lastname: Perera
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rauscher
authors.affiliation: Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: A Dessa
authors.initials: AD
authors.lastname: Sadovnick
authors.affiliation: Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Szkup
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: David K
authors.initials: DK
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001401:Azygos Vein / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D010690:Phlebography / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D035781:Siblings; D016037:Single-Blind Method; D014689:Venous Insufficiency / Q000209:etiology; D055815:Young Adult
keywords: Chronic cerebrospinal venous insufficiency; Magnetic resonance venography; Multiple sclerosis; Time-of-flight