Comparison of MR and Contrast Venography of the Cervical Venous System in Multiple Sclerosis
G. Zaharchuk, N.J. Fischbein, J. Rosenberg, R.J. Herfkens and M.D. Dake
From the Departments of Radiology (G.Z., J.R., R.J.H.) and Cardiothoracic Surgery (M.D.D.), Stanford University, Stanford, California; Department of Radiology (G.Z., N.J.F., R.J.H.), Stanford University Medical Center, Stanford, California.
BACKGROUND AND PURPOSE: MRV has been proposed as a possible screening method to identify chronic cerebrospinal venous insufficiency, which may play a role in MS. We report our initial experience comparing MRV and CV in MS patients to evaluate venous stenosis and collateral venous drainage.
MATERIALS AND METHODS: Time-of-flight and time-resolved imaging of contrast kinetics MRV and CV were performed in 39 MS patients. The presence and severity of both IJ vein caliber changes and non-IJ collaterals were graded by using a 4-point scale by 2 radiologists in an independent and blinded manner.
RESULTS: Both studies frequently showed venous abnormalities, most commonly IJ flattening at the C1 level and in the lower neck. There was moderate-to-good agreement between the modalities ( = 0.55; 95% CI, 0.45%–0.65%). For collaterals, agreement was only fair ( = 0.30; 95% CI, 0.09%–0.50%). The prevalence of IJ segments graded mild or worse on CV was 54%. If CV was considered a standard, the sensitivity and specificity of MRV was 0.79 (0.71–0.86) and 0.76 (0.67–0.83), respectively. Degree of stenosis was related to the severity of collaterals for CV but not for MRV.
CONCLUSIONS: IJ caliber changes were seen in characteristic locations on both MRV and CV in MS patients. Agreement between modalities was higher for stenosis than for collaterals. If CV is considered a standard, MRV performance is good but may require additional improvement before MRV can be used for screening.
Did I miss a discussion of this one? It came out two weeks ago. Dr. Dake is one of the authors.
They found CCSVI both by MRV and by catheter venogram. There was not perfect agreement between the two. On catheter venogram, they found that the degree of stenosis was related to the severity of collaterals. That makes sense: the worse the blockage, the more collaterals the body has recruited to go around the blockage. The most common CCSVI abnormality was flattening of the internal jugular vein at the c1 level and at the lower neck, where the valves are located.