Chronic cerebrospinal venous insufficiency in multiple sclerosis: A sonographer-blinded case-control study

Background: Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a possible cause of multiple sclerosis (MS). Objectives: The CoSMo study evaluated the association between CCSVI and MS. Methods: The primary end-point of this multicentric, case-control study was to compare the prevalence of CCSVI between patients with MS, patients with other neurodegenerative diseases (ONDs) and healthy controls (HCs). Color-coded duplex sonography was performed by a sonologist and the images were sent to one of three central sonologists for a second reading. Agreement between local and central sonologists or, in case of disagreement, the predominant judgment among the three central readers, was required for a diagnosis of CCSVI. All readings, data collection and analysis were blinded. Results: The study involved 35 MS centers across Italy and included 1874 subjects aged 18–55. 1767 (94%) were evaluable: 1165 MS patients, 226 patients with ONDs and 376 HCs. CCSVI prevalence was 3.26%, 3.10% and 2.13% for the MS, OND and HC groups, respectively. No significant difference in CCSVI prevalence was found amongst the three cohorts (MS versus HC, OR = 1.55, 95%CI = 0.72–3.36, p = 0.30; OND versus HC, OR = 1.47, 95%CI = 0.53–4.11, p = 0.46; MS versus OND, OR = 1.05, 95%CI = 0.47–2.39, p = 0.99). High negative and low positive agreement was found between the local and centralized readers. Conclusions: CCSVI is not associated with MS.

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Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case–control study

BMC Health Services Research ◽

10.1186/s12913-015-0835-y ◽

2015 ◽

Vol 15 (1) ◽

Author(s):

Michelle Ploughman ◽

Olivia J Manning ◽

Serge Beaulieu ◽

Chelsea Harris ◽

Stephen H Hogan ◽

...

Keyword(s):

Multiple Sclerosis ◽

Older People ◽

Venous Insufficiency ◽

Case Control Study ◽

Case Control ◽

Chronic Cerebrospinal Venous Insufficiency ◽

Control Study

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Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis: A case-control study from Iran

Perspectives in Medicine ◽

10.1016/j.permed.2012.02.037 ◽

2012 ◽

Vol 1 (1-12) ◽

pp. 375-380 ◽

Cited By ~ 2

Author(s):

Masoud Mehrpour ◽

Neda Najimi ◽

Seyed-Mohammad Fereshtehnejad ◽

Fatemeh Naderi Safa ◽

Samira Mirzaeizadeh ◽

...

Keyword(s):

Multiple Sclerosis ◽

Venous Insufficiency ◽

Case Control Study ◽

Case Control ◽

Chronic Cerebrospinal Venous Insufficiency ◽

Control Study

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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

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2016.07.002 ◽

2017 ◽

Vol 68 (2) ◽

pp. 202-209 ◽

Cited By ~ 3

Author(s):

Nancy Martin ◽

Anthony L. Traboulsee ◽

Lindsay Machan ◽

Darren Klass ◽

Tasha Ellchuk ◽

...

Keyword(s):

Multiple Sclerosis ◽

Magnetic Resonance ◽

Gold Standard ◽

Venous Insufficiency ◽

Case Control Study ◽

Study Groups ◽

Case Control ◽

Significant Difference ◽

High Prevalence ◽

Control Study

Purpose 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. Conclusion 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.

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