1
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Aglamis S, Gönen M. Flow volume measurement of arterial venous and cerebrospinal fluid in patients with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:706-711. [PMID: 36254443 PMCID: PMC9685823 DOI: 10.1055/s-0042-1755276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Background Multiple sclerosis (MS) is usually described as an autoimmune disease, although the exact mechanism of the disease remains unknown. There have been studies reporting that venous flow abnormalities may be involved in the pathogenesis of MS or many of the associated clinical manifestations.
Objective The aim of this study was to evaluate flow volumes of the middle cerebral artery (MCA), transverse sinus (TS), and cerebral aqueduct using phase contrast magnetic resonance imaging (PC-MRI) in relapsing-remitting MS patients and a control group.
Methods We included 34 patients diagnosed by the McDonald criteria, revised in 2017, as well as 15 healthy controls matched by age and sex. The MRI scans were performed using a 1.5-T superconducting scanner. Axial T1-weighted, T2-weighted, and PC-MRI sequences were performed for the quantitative investigation of flow volume measurements. Quantitative analyses of flows were performed using flow analyses program PC-MRI angiography software. A circular region of interest was placed manually into the cerebral aqueduct, bilateral MCA, and TS.
Results Flow volumes of the cerebral aqueduct and MCA were not statistically significant between the MS and control groups. The flow volumes of the TS for the patient group were lower than those of the control group, and this difference was statistically significant.
Conclusions A reduced TS flow volume in MS patients was noted in the present study when compared with the control group, suggesting a relation between venous pathologies and MS. Further studies are needed to understand whether this relation is causal or epiphenomenal.
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Affiliation(s)
- Serpil Aglamis
- Firat University, Faculty of Medicine, Department of Radiology, Elazig, Turkey
| | - Murat Gönen
- Firat University, Faculty of Medicine, Department of Neurology, Elazig, Turkey
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2
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Tucker T. Fluid dynamics of cerebrospinal venous flow in multiple sclerosis. Med Hypotheses 2019; 131:109255. [DOI: 10.1016/j.mehy.2019.109255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/27/2019] [Accepted: 06/01/2019] [Indexed: 02/06/2023]
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3
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Belov P, Jakimovski D, Krawiecki J, Magnano C, Hagemeier J, Pelizzari L, Weinstock-Guttman B, Zivadinov R. Lower Arterial Cross-Sectional Area of Carotid and Vertebral Arteries and Higher Frequency of Secondary Neck Vessels Are Associated with Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:123-130. [PMID: 29217748 DOI: 10.3174/ajnr.a5469] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/17/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Arterial and neck vessel system characteristics of patients with multiple sclerosis have not been previously investigated. Therefore, the aim of this study was to examine the frequency of neck vessels and their cross-sectional areas (in square millimeters) between patients with MS and healthy controls. MATERIALS AND METHODS In this study, 193 patients with MS and 193 age- and sex-matched healthy controls underwent 2D TOF venography at 3T. The main arterial (carotid and vertebral), venous (internal jugular), and secondary neck vessels were examined at 4 separate cervical levels (C2/3, C4, C5/6, and C7/T1). The ANCOVA adjusted for age, body mass index, smoking status, hypertension, and heart disease was used to compare the differences between patients with MS and healthy controls. RESULTS After controlling for all confounding factors, patients with MS had significantly lower cross-sectional areas of the carotid arteries at the C2/3 (P = .03), C5/6 (P = .026), and C7/T1 (P = .005) levels as well as of the vertebral arteries at the C2/3 (P = .02), C4 (P = .012), and C7/T1 (P = .006) levels, compared with healthy controls. A higher frequency of secondary neck vessels was found at all 4 levels in patients with MS: C2/3 (12.9 versus 10, P < .001), C4 (9.1 versus 7.5, P < .001), C5/6 (7.8 versus 6.8, P = .012), and C7/T1 (8.8 versus 6, P < .001). The total cross-sectional areas of secondary neck vessels were also significantly higher at all 4 levels (P < .03). No significant differences in the cross-sectional areas of jugular veins were found between patients with MS and healthy controls. CONCLUSIONS Patients with MS showed lower cross-sectional areas of the carotid and vertebral arteries and a higher frequency of secondary neck vessels and their cross-sectional areas compared with healthy controls.
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Affiliation(s)
- P Belov
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - D Jakimovski
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - J Krawiecki
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - C Magnano
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - J Hagemeier
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
| | - L Pelizzari
- Department of Electronics, Information and Bioengineering (L.P.), Politecnico di Milano, Milan, Italy
- Fondazione Don Carlo Gnocchi Organizzazione Non Lucrativa di Utilita' Sociae (L.P.), Milan, Italy
| | | | - R Zivadinov
- From the Buffalo Neuroimaging Analysis Center, Department of Neurology (P.B., D.J., J.K., C.M., J.H., R.Z.)
- Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, Buffalo, New York
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4
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Sethi SK, Daugherty AM, Gadda G, Utriainen DT, Jiang J, Raz N, Haacke EM. Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow. AJNR Am J Neuroradiol 2017; 38:1617-1622. [PMID: 28546249 DOI: 10.3174/ajnr.a5219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE To date, research on extracranial venous collaterals has been focused on structure, with relatively little attention paid to hemodynamics. We addressed this limitation by quantitatively comparing collateral flow in patients with multiple sclerosis and healthy controls by using phase-contrast MR imaging. We hypothesize that patients with MS with structurally anomalous internal jugular veins will have elevated collateral venous flow compared with healthy controls. MATERIALS AND METHODS The sample consisted of 276 patients with MS and 106 healthy controls. We used MRV to classify internal jugular veins as stenotic and nonstenotic based on an absolute cross-sectional area threshold in 276 patients with MS and 60 healthy controls; 46 healthy controls lacked this imaging. Individual and total vessel flows were quantified by using phase-contrast MR imaging on all patients. Veins were classified by extracranial drainage type: internal jugular veins (I), paraspinal (II), and superficial (III). Differences among healthy controls, patients with MS, nonstenotic patients, and stenotic subgroups in total venous flow by vessel type were evaluated in a general linear model for statistical analysis. RESULTS In the MS group, 153 patients (55%) evidenced stenosis, whereas 12 (20%) healthy controls were classified as stenotic (P < .001). Compared with healthy controls, the MS group showed lower type I flow and increased type II flow. Stenosis was associated with reduced flow in the type I vessels [F(1272) = 68; P < .001]. The stenotic MS group had increased flow in the type II vessels compared with the nonstenotic MS group [F(1272) = 67; P < .001]. CONCLUSIONS Compared with healthy controls, patients with MS exhibit reduced venous flow in the main extracerebral drainage vein (internal jugular vein). In contrast, flow in the paraspinal venous collaterals is elevated in patients with MS and exacerbated by venous stenosis. Collateral drainage may be a compensatory response to internal jugular vein flow reduction.
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Affiliation(s)
- S K Sethi
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | | | - G Gadda
- Department of Physics and Earth Sciences (G.G.), University of Ferrara, Ferrara, Italy
| | - D T Utriainen
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | - J Jiang
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | - N Raz
- Institute of Gerontology (A.M.D., N.R.)
- Departments of Psychology (N.R.)
| | - E M Haacke
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
- Radiology (E.M.H.), Wayne State University, Detroit, Michigan
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5
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Schrauben EM, Kohn S, Macdonald J, Johnson KM, Kliewer M, Frost S, Fleming JO, Wieben O, Field A. Four-dimensional flow magnetic resonance imaging and ultrasound assessment of cerebrospinal venous flow in multiple sclerosis patients and controls. J Cereb Blood Flow Metab 2017; 37:1483-1493. [PMID: 27364001 PMCID: PMC5453467 DOI: 10.1177/0271678x16657345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Eric M Schrauben
- 1 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sarah Kohn
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Jacob Macdonald
- 3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA
| | - Kevin M Johnson
- 3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA
| | - Mark Kliewer
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Sam Frost
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - John O Fleming
- 4 Department of Neurology, University of Wisconsin-Madison, Madison, USA
| | - Oliver Wieben
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.,3 Department of Medical Physics, University of Wisconsin-Madison, Madison, USA
| | - Aaron Field
- 2 Department of Radiology, University of Wisconsin-Madison, Madison, USA.,5 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, USA
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Kefayati S, Amans M, Faraji F, Ballweber M, Kao E, Ahn S, Meisel K, Halbach V, Saloner D. The manifestation of vortical and secondary flow in the cerebral venous outflow tract: An in vivo MR velocimetry study. J Biomech 2017; 50:180-187. [PMID: 27894675 PMCID: PMC5191981 DOI: 10.1016/j.jbiomech.2016.11.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
Aberrations in flow in the cerebral venous outflow tract (CVOT) have been implicated as the cause of several pathologic conditions including idiopathic intracranial hypertension (IIH), multiple sclerosis (MS), and pulsatile tinnitus (PT). The advent of 4D flow magnetic resonance imaging (4D-flow MRI) has recently allowed researchers to evaluate blood flow patterns in the arterial structures with great success. We utilized similar imaging techniques and found several distinct flow characteristics in the CVOT of subjects with and without lumenal irregularities. We present the flow patterns of 8 out of 38 subjects who have varying heights of the internal jugular bulb and varying lumenal irregularities including stenosis and diverticulum. In the internal jugular vein (IJV) with an elevated jugular bulb (JB), 4Dflow MRI revealed a characteristic spiral flow that was dependent on the level of JB elevation. Vortical flow was also observed in the diverticula of the venous sinuses and IJV. The diversity of flow complexity in the CVOT illustrates the potential importance of hemodynamic investigations in elucidating venous pathologies.
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Affiliation(s)
- Sarah Kefayati
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Matthew Amans
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Farshid Faraji
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Megan Ballweber
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Evan Kao
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | | | - Karl Meisel
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Van Halbach
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA; Radiology Service, VA Medical Center, San Francisco, USA
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7
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Martin N, Traboulsee AL, Machan L, Klass D, Ellchuk T, Zhao Y, Knox KB, Kopriva D, Lala S, Nickel D, Otani R, Perera WR, Rauscher A, Sadovnick AD, Szkup P, Li DK. 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. Can Assoc Radiol J 2016; 68:202-209. [PMID: 27887935 DOI: 10.1016/j.carj.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/09/2016] [Accepted: 07/06/2016] [Indexed: 10/20/2022] Open
Abstract
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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Affiliation(s)
- Nancy Martin
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Anthony L Traboulsee
- Department of Medicine (Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren Klass
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tasha Ellchuk
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine B Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Kopriva
- Department of Surgery, College of Medicine, University of Saskatchewan and Regina Qu'Appelle Health Region (Section of Vascular Surgery), Regina, Saskatchewan, Canada
| | - Shantilal Lala
- Department of Medical Imaging, College of Medicine, University of Saskatchewan and Regina Qu-Appelle Health Region, Regina, Saskatchewan, Canada
| | - Darren Nickel
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert Otani
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Warren R Perera
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Dessa Sadovnick
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Szkup
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David K Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Intra- and Extracranial MR Venography: Technical Notes, Clinical Application, and Imaging Development. Behav Neurol 2016; 2016:2694504. [PMID: 27340338 PMCID: PMC4906191 DOI: 10.1155/2016/2694504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
Scientific debate over chronic cerebrospinal venous insufficiency (CCSVI) has drawn attention to venous system involvement in a series of pathologic brain conditions. In the last few decades, the MRI venography (MRV) field has developed a number of valuable sequences to better investigate structural anatomy, vessel patency, and flow characteristics of venous drainage in the intra- and extracranial systems. A brief two-tier protocol is proposed to encompass the study of intra- and extracranial venous drainage with and without contrast administration, respectively. Contrast-enhanced protocol is based on time-resolved contrast-enhanced MRV of the whole region plus extracranial flow quantification through 2D Cine phase contrast (PC); non-contrast-enhanced protocol includes intracranial 3D PC, extracranial 2D time of flight (TOF), and 2D Cine PC flow quantification. Total scanning time is reasonable for clinical applications: approximately seven minutes is allocated for the contrast protocol (most of which is due to 2D Cine PC), while the noncontrast protocol accounts for around twenty minutes. We believe that a short though exhaustive MRI scan of the whole intra- and extracranial venous drainage system can be valuable for a variety of pathologic conditions, given the possible venous implication in several neurological conditions.
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9
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Beggs CB, Magnano C, Belov P, Krawiecki J, Ramasamy DP, Hagemeier J, Zivadinov R. Internal Jugular Vein Cross-Sectional Area and Cerebrospinal Fluid Pulsatility in the Aqueduct of Sylvius: A Comparative Study between Healthy Subjects and Multiple Sclerosis Patients. PLoS One 2016; 11:e0153960. [PMID: 27135831 PMCID: PMC4852898 DOI: 10.1371/journal.pone.0153960] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 04/06/2016] [Indexed: 12/25/2022] Open
Abstract
Objectives Constricted cerebral venous outflow has been linked with increased cerebrospinal fluid (CSF) pulsatility in the aqueduct of Sylvius in multiple sclerosis (MS) patients and healthy individuals. This study investigates the relationship between CSF pulsatility and internal jugular vein (IJV) cross-sectional area (CSA) in these two groups, something previously unknown. Methods 65 relapsing-remitting MS patients (50.8% female; mean age = 43.8 years) and 74 healthy controls (HCs) (54.1% female; mean age = 43.9 years) were investigated. CSF flow quantification was performed on cine phase-contrast MRI, while IJV-CSA was calculated using magnetic resonance venography. Statistical analysis involved correlation, and partial least squares correlation analysis (PLSCA). Results PLSCA revealed a significant difference (p<0.001; effect size = 1.072) between MS patients and HCs in the positive relationship between CSF pulsatility and IJV-CSA at C5-T1, something not detected at C2-C4. Controlling for age and cardiovascular risk factors, statistical trends were identified in HCs between: increased net positive CSF flow (NPF) and increased IJV-CSA at C5-C6 (left: r = 0.374, p = 0.016; right: r = 0.364, p = 0.019) and C4 (left: r = 0.361, p = 0.020); and increased net negative CSF flow and increased left IJV-CSA at C5-C6 (r = -0.348, p = 0.026) and C4 (r = -0.324, p = 0.039), whereas in MS patients a trend was only identified between increased NPF and increased left IJV-CSA at C5-C6 (r = 0.351, p = 0.021). Overall, correlations were weaker in MS patients (p = 0.015). Conclusions In healthy adults, increased CSF pulsatility is associated with increased IJV-CSA in the lower cervix (independent of age and cardiovascular risk factors), suggesting a biomechanical link between the two. This relationship is altered in MS patients.
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Affiliation(s)
- Clive B. Beggs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- Research Institute for Sport, Physical Activity and Leisure, Carnegie Faculty, Leeds Beckett University, Leeds, West Yorkshire, United Kingdom
- * E-mail:
| | - Christopher Magnano
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Pavel Belov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Jacqueline Krawiecki
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Deepa P. Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
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10
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Torres C, Hogan M, Patro S, Chakraborty S, Nguyen T, Thornhill R, Freedman M, Bussiere M, Dabirzadeh H, Schwarz BA, Belanger S, Legault-Kingstone L, Schweitzer M, Lum C. Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant? Eur Radiol 2016; 27:239-246. [PMID: 27011374 DOI: 10.1007/s00330-016-4314-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/28/2015] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population. MATERIALS AND METHODS We prospectively recruited 100 patients without MS, aged 18-60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins. RESULTS Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon. CONCLUSION It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients. KEY POINTS • The venous anatomy of the neck in patients without MS demonstrates multiple variants • Asymmetry and stenoses of the internal jugular veins are common • Collateral neck veins are not uncommon in patients without MS • These findings do not support the theory of chronic cerebrospinal venous insufficiency • MR venography is a useful imaging modality for assessing venous anatomy.
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Affiliation(s)
- Carlos Torres
- Department of Radiology, University of Ottawa, Ottawa, ON, K1Y 4E9, Canada. .,Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute OHRI, Ottawa, ON, Canada.
| | - Matthew Hogan
- Ottawa Hospital Research Institute OHRI, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Satya Patro
- Department of Radiology, University of Ottawa, Ottawa, ON, K1Y 4E9, Canada.,Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada
| | - Santanu Chakraborty
- Department of Radiology, University of Ottawa, Ottawa, ON, K1Y 4E9, Canada.,Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada.,Ottawa Hospital Research Institute OHRI, Ottawa, ON, Canada
| | - Thanh Nguyen
- Department of Radiology, University of Ottawa, Ottawa, ON, K1Y 4E9, Canada.,Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada.,Ottawa Hospital Research Institute OHRI, Ottawa, ON, Canada
| | - Rebecca Thornhill
- Department of Radiology, University of Ottawa, Ottawa, ON, K1Y 4E9, Canada.,Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada.,Ottawa Hospital Research Institute OHRI, Ottawa, ON, Canada
| | - Mark Freedman
- Ottawa Hospital Research Institute OHRI, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Miguel Bussiere
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
| | - Hamid Dabirzadeh
- Department of Radiology, University of Saskatchewan, Neuroradiologist, Saskatoon, Canada
| | - Betty Anne Schwarz
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada
| | - Stefanie Belanger
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada
| | - Lysa Legault-Kingstone
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada
| | - Mark Schweitzer
- Department of Radiology, Stony Brook School of Medicine, Stony Brook, NY, USA
| | - Cheemun Lum
- Department of Radiology, University of Ottawa, Ottawa, ON, K1Y 4E9, Canada.,Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada.,Ottawa Hospital Research Institute OHRI, Ottawa, ON, Canada
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Variability in the Cross-Sectional Area and Narrowing of the Internal Jugular Vein in Patients Without Multiple Sclerosis. AJR Am J Roentgenol 2016; 206:1082-6. [PMID: 26958902 DOI: 10.2214/ajr.15.14689] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Chronic cerebrospinal vascular insufficiency is a proposed condition of intraluminal stenosis of the internal jugular vein (IJV) that impedes venous flow from the brain. Calculations of IJV stenosis are vague and described in veins with at least a 50% reduction in IJV caliber at a specific level. The purpose of this study was to assess normal changes in anatomic caliber of the course of the IJV in a generalized population. MATERIALS AND METHODS Images from 500 consecutive contrast-enhanced neck CT studies performed in January-July 2011 were reviewed. Cross-sectional areas of the IJV were calculated at the jugular foramen, C1-C7 levels, and jugular angles bilaterally. Patients were excluded if they had severely motion-limited studies; limited clinical data; a history of multiple sclerosis, neck mass, or neck dissection; or known IJV occlusion. Normalized IJV cross-sectional areas at each level were compared with an averaged normalized cross-sectional area from all patients at each level. RESULTS Greater than 50% narrowing compared with a normalized average was found in 133 of 363 patients (36.6%) and was seen at all IJV levels. In 36.1% of patients this narrowing occurred at the C1 level. Most of the areas of narrowing greater than 50% occurred above the C4 level. CONCLUSION The IJV has marked variability in its course in the neck. Areas of narrowing greater than 50% occur most commonly in the upper cervical and skull base regions. Given the normal anatomic variations in IJV caliber, caution should be used when making the diagnosis of and treating IJV stenosis.
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Jang J, Kim BS, Sung J, Kim BY, Choi HS, Jung SL, Ahn KJ. Subtraction MR Venography Acquired from Time-Resolved Contrast-Enhanced MR Angiography: Comparison with Phase-Contrast MR Venography and Single-Phase Contrast-Enhanced MR Venography. Korean J Radiol 2015; 16:1353-63. [PMID: 26576127 PMCID: PMC4644759 DOI: 10.3348/kjr.2015.16.6.1353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/21/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the image characteristics of subtraction magnetic resonance venography (SMRV) from time-resolved contrast-enhanced MR angiography (TRMRA) compared with phase-contrast MR venography (PCMRV) and single-phase contrast-enhanced MR venography (CEMRV). MATERIALS AND METHODS Twenty-one patients who underwent brain MR venography (MRV) using standard protocols (PCMRV, CEMRV, and TRMRA) were included. SMRV was made by subtracting the arterial phase data from the venous phase data in TRMRA. Co-registration and subtraction of the two volume data was done using commercially available software. Image quality and the degree of arterial contamination of the three MRVs were compared. In the three MRVs, 19 pre-defined venous structures (14 dural sinuses and 5 cerebral veins) were evaluated. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the three MRVs were also compared. RESULTS Single-phase contrast-enhanced MR venography showed better image quality (median score 4 in both reviewers) than did the other two MRVs (p < 0.001), whereas SMRV (median score 3 in both reviewers) and PCMRV (median score 3 in both reviewers) had similar image quality (p ≥ 0.951). SMRV (median score 0 in both reviewers) suppressed arterial signal better than did the other MRVs (median score 1 in CEMRV, median score 2 in PCMRV, both reviewers) (p < 0.001). The dural sinus score of SMRV (median and interquartile range [IQR] 48, 43-50 for reviewer 1, 47, 43-49 for reviewer 2) was significantly higher than for PCMRV (median and IQR 31, 25-34 for reviewer 1, 30, 23-32 for reviewer 2) (p < 0.01) and did not differ from that of CEMRV (median and IQR 50, 47-52 for reviewer 1, 49, 45-51 for reviewer 2) (p = 0.146 in reviewer 1 and 0.123 in reviewer 2). The SNR and CNR of SMRV (median and IQR 104.5, 83.1-121.2 and 104.1, 74.9-120.5, respectively) were between those of CEMRV (median and IQR 150.3, 111-182.6 and 148.4, 108-178.2) and PCMRV (median and IQR 59.4, 49.2-74.9 and 53.6, 43.8-69.2). CONCLUSION Subtraction magnetic resonance venography is a promising MRV method, with acceptable image quality and good arterial suppression.
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Affiliation(s)
- Jinhee Jang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jinkyeong Sung
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea
| | - Bom-Yi Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Hyun Seok Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - So-Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kook-Jin Ahn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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Recommendations for Multimodal Noninvasive and Invasive Screening for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal Venous Insufficiency: A Position Statement of the International Society for Neurovascular Disease. J Vasc Interv Radiol 2014; 25:1785-94.e17. [DOI: 10.1016/j.jvir.2014.07.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022] Open
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Raz E, Pontecorvo S, Barra V, Marincola BC, Morreale M, Tinelli E, Saba L, Di Paolo PL, Aceti A, Catalano C, Francia A, Caramia F. MR venography in patients with multiple sclerosis and correlation with clinical and MRI parameters. J Neuroimaging 2014; 24:492-7. [PMID: 25340182 DOI: 10.1111/jon.12066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) has been associated with chronic cerebrospinal venous insufficiency. We aim to evaluate the correlation between extracranial veins stenosis evaluated with MR venography (MRV) and clinical/MR parameters of MS. METHODS In 29 consecutive MS patients we performed a standard brain MRI protocol, completed by the evaluation of extra-cerebral venous system using a phase-contrast and a Volumetric Interpolated Breath Hold Examination (VIBE) sequence before and after gadolinium. The T2-proton density images were used to calculate the lesion volume. The jugular veins were evaluated qualitatively (in terms of presence and severity of stenoses) and quantitatively (degree of stenosis). The phase-contrast images were analyzed to calculate the average and peak velocity in the internal jugular veins. RESULTS Postcontrast VIBE successfully showed the jugular veins in all the subjects. T2-lesion-volume was 8.2 [4.6] cm³. A stenosis of the internal jugular veins > of 50% was observed in 10/29(33%) patients. No significant correlation was observed between T2-lesion-volume and degree-of-stenosis (r = .362, P = .302). No different flow parameters were found in the subgroups of patients with and without stenosis (P = .54). CONCLUSIONS In MS the presence/severity of jugular vein stenosis identified with 3T-MRV is not related to MR-visible tissue damage. Moreover no abnormal flow parameters were found in stenosed veins.
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Jandaghi AB, Amanian D, Roudbari SA, Kanafi AR, Pourghorban R. Evaluation of hemodynamic properties of cerebral venous drainage in patients with multiple sclerosis: a case-control study. Pol J Radiol 2014; 79:323-7. [PMID: 25250100 PMCID: PMC4170839 DOI: 10.12659/pjr.890690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/08/2014] [Indexed: 11/09/2022] Open
Abstract
Background The purpose of this study was to compare patients with multiple sclerosis and healthy control subjects as regards hemodynamics of cerebral venous drainage. Material/Methods Between December 2012 and May 2013, 44 consecutive patients with multiple sclerosis and 44 age- and sex-matched healthy subjects underwent the B-mode, color Doppler, and duplex Doppler evaluations of the internal jugular vein (IJV) and vertebral vein. The following four parameters were investigated: IJV stenosis, reversal of postural control of the cerebral venous outflow pathways, absence of detectable blood flow in the IJVs and/or vertebral veins, and reflux in the IJVs and/or vertebral veins in the sitting or supine position. Results In the study group, IJV stenosis, postural control reversal of the cerebral venous outflow pathways, and absence of flow in the IJVs and/or vertebral veins were found in 3 (6.8%), 2 (4.5%), and 3 (6.8%) patients, respectively. In the control group, IJV stenosis (P=0.12), postural control reversal of the cerebral venous outflow pathways (P=0.50), and absence of flow (P=0.12) were not detected. Abnormal reflux was found neither in multiple sclerosis patients nor in healthy subjects. Conclusions No significant difference in the cerebral venous drainage through the IJV or vertebral vein was found between patients with multiple sclerosis and healthy subjects within any of the investigated ultrasonographic parameters.
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Affiliation(s)
- Ali Babaei Jandaghi
- Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran ; Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Dayan Amanian
- Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyed Ali Roudbari
- Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Ramin Pourghorban
- Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zivadinov R, Chung CP. Potential involvement of the extracranial venous system in central nervous system disorders and aging. BMC Med 2013; 11:260. [PMID: 24344742 PMCID: PMC3866257 DOI: 10.1186/1741-7015-11-260] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 11/22/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system. DISCUSSION A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow. SUMMARY Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
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17
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What is the relationship between chronic cerebrospinal venous insufficiency and multiple sclerosis? ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.rvm.2013.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Schrauben EM, Johnson KM, Huston J, Del Rio AM, Reeder SB, Field A, Wieben O. Reproducibility of cerebrospinal venous blood flow and vessel anatomy with the use of phase contrast-vastly undersampled isotropic projection reconstruction and contrast-enhanced MRA. AJNR Am J Neuroradiol 2013; 35:999-1006. [PMID: 24287088 DOI: 10.3174/ajnr.a3779] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE The chronic cerebrospinal venous insufficiency hypothesis raises interest in cerebrospinal venous blood flow imaging, which is more complex and less established than in arteries. For accurate assessment of venous flow in chronic cerebrospinal venous insufficiency diagnosis and research, we must account for physiologic changes in flow patterns. This study examines day-to-day flow variability in cerebrospinal veins by use of 4D MR flow and contrast-enhanced MRA under typical, uncontrolled conditions in healthy individuals. MATERIALS AND METHODS Ten healthy volunteers were scanned in a test-retest fashion by use of a 4D flow MR imaging technique and contrast-enhanced MRA. Flow parameters obtained from phase contrast-vastly undersampled isotropic projection reconstruction and contrast-enhanced MRA scoring measurements in the head, neck, and chest veins were analyzed for internal consistency and interscan reproducibility. RESULTS Internal consistency was satisfied at the torcular herophili, with an input-output difference of 2.2%. Percentages of variations in flow were 20.3%, internal jugular vein; 20.4%, azygos vein; 6.8%, transverse sinus; and 5.1%, common carotid artery. Retrograde flow was found in the lower internal jugular vein (4.8%) and azygos vein (7.2%). Contrast-enhanced MRA interscan κ values for the internal jugular vein (left: 0.474, right: 0.366) and azygos vein (-0.053) showed poor interscan agreement. CONCLUSIONS Phase contrast-vastly undersampled isotropic projection reconstruction blood flow measurements are reliable and highly reproducible in intracranial veins and in the common carotid artery but not in veins of the neck (internal jugular vein) and chest (azygos vein) because of normal physiologic variation. Retrograde flow normally may be observed in the lower internal jugular vein and azygos vein. Low interrater agreement in contrast-enhanced MRA scans was observed. These findings have important implications for imaging diagnosis and experimental research of chronic cerebrospinal venous insufficiency.
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Affiliation(s)
- E M Schrauben
- From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.)
| | - K M Johnson
- From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.)
| | - J Huston
- Radiology (J.H., S.B.R., A.F., O.W.), University of Wisconsin, Madison, Wisconsin
| | - A M Del Rio
- From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.)
| | - S B Reeder
- From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.)Radiology (J.H., S.B.R., A.F., O.W.), University of Wisconsin, Madison, Wisconsin
| | - A Field
- Radiology (J.H., S.B.R., A.F., O.W.), University of Wisconsin, Madison, Wisconsin
| | - O Wieben
- From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.)Radiology (J.H., S.B.R., A.F., O.W.), University of Wisconsin, Madison, Wisconsin
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Zivadinov R, Karmon Y, Dolic K, Hagemeier J, Marr K, Valnarov V, Kennedy CL, Hojnacki D, Carl EM, Hopkins LN, Levy EI, Weinstock-Guttman B, Siddiqui AH. Multimodal noninvasive and invasive imaging of extracranial venous abnormalities indicative of CCSVI: results of the PREMiSe pilot study. BMC Neurol 2013; 13:151. [PMID: 24139135 PMCID: PMC4015359 DOI: 10.1186/1471-2377-13-151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 10/14/2013] [Indexed: 11/10/2022] Open
Abstract
Background There is no established noninvasive or invasive diagnostic imaging modality at present that can serve as a ‘gold standard’ or “benchmark” for the detection of the venous anomalies, indicative of chronic cerebrospinal venous insufficiency (CCSVI). We investigated the sensitivity and specificity of 2 invasive vs. 2 noninvasive imaging techniques for the detection of extracranial venous anomalies in the internal jugular veins (IJVs) and azygos vein/vertebral veins (VVs) in patients with multiple sclerosis (MS). Methods The data for this multimodal imaging comparison pilot study was collected in phase 2 of the “Prospective Randomized Endovascular therapy in Multiple Sclerosis” (PREMiSe) study using standardized imaging techniques. Thirty MS subjects were screened initially with Doppler sonography (DS), out of which 10 did not fulfill noninvasive screening procedure requirements on DS that consisted of ≥2 venous hemodynamic extracranial criteria. Accordingly, 20 MS patients with relapsing MS were enrolled into the multimodal diagnostic imaging study. For magnetic resonance venography (MRV), IJVs abnormal findings were considered absent or pinpoint flow, whereas abnormal VVs flow was classified as absent. Abnormalities of the VVs were determined only using non-invasive testing. Catheter venography (CV) was considered abnormal when ≥50% lumen restriction was detected, while intravascular ultrasound (IVUS) was considered abnormal when ≥50% restriction of the lumen or intra-luminal defects or reduced pulsatility was found. Non-invasive and invasive imaging modality comparisons between left, right and total IJVs and between the VVs and azygos vein were performed. Because there is no reliable way of non-invasively assessing the azygos vein, the VVs abnormalities detected by the non-invasive testing were compared to the azygos abnormalities detected by the invasive testing. All image modalities were analyzed in a blinded manner by more than one viewer, upon which consensus was reached. The sensitivity and specificity were calculated using contingency tables denoting the presence or absence of vein-specific abnormality findings between all imaging modalities used individually as the benchmark. Results The sensitivity of CV + IVUS was 68.4% for the right and 90% for the left IJV and 85.7% for the azygos vein/VVs, compared to venous anomalies detected on DS. Compared to the venous anomalies detected on MRV, the sensitivity of CV + IVUS was 71.4% in right and 100% in left IJVs and 100% in the azygos vein/VVs; however, the specificity was 38.5%, 38.9% and 11.8%, respectively. The sensitivity between the two invasive imaging techniques, used as benchmarks, ranged from 72.7% for the right IJV to 90% for the azygos vein but the IVUS showed a higher rate of venous anomalies than the CV. There was excellent correspondence between identifying collateral veins on MRV and CV. Conclusions Noninvasive DS screening for the detection of venous anomalies indicative of CCSVI may be a reliable approach for identifying patients eligible for further multimodal invasive imaging testing of the IJVs. However, the noninvasive screening methods were inadequate to depict the total amount of azygos vein/VVs anomalies identified with invasive testing. This pilot study, with limited sample size, shows that both a non-invasive and invasive multimodal imaging diagnostic approach should be recommended to depict a range of extracranial venous anomalies indicative of CCSVI. However, lack of invasive testing on the study subjects whose results were negative on the DS screening and of healthy controls, limits further generalizibility of our findings. In addition, the findings from the 2 invasive techniques confirmed the existence of severe extracranial venous anomalies that significantly impaired normal blood outflow from the brain in this group of MS patients.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, USA.
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Alexander JS, Prouty L, Tsunoda I, Ganta CV, Minagar A. Venous endothelial injury in central nervous system diseases. BMC Med 2013; 11:219. [PMID: 24228622 PMCID: PMC3851779 DOI: 10.1186/1741-7015-11-219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 09/09/2013] [Indexed: 02/08/2023] Open
Abstract
The role of the venous system in the pathogenesis of inflammatory neurological/neurodegenerative diseases remains largely unknown and underinvestigated. Aside from cerebral venous infarcts, thromboembolic events, and cerebrovascular bleeding, several inflammatory central nervous system (CNS) diseases, such as multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and optic neuritis, appear to be associated with venous vascular dysfunction, and the neuropathologic hallmark of these diseases is a perivenous, rather than arterial, lesion. Such findings raise fundamental questions about the nature of these diseases, such as the reasons why their pathognomonic lesions do not develop around the arteries and what exactly are the roles of cerebral venous inflammation in their pathogenesis. Apart from this inflammatory-based view, a new hypothesis with more focus on the hemodynamic features of the cerebral and extracerebral venous system suggests that MS pathophysiology might be associated with the venous system that drains the CNS. Such a hypothesis, if proven correct, opens new therapeutic windows in MS and other neuroinflammatory diseases. Here, we present a comprehensive review of the pathophysiology of MS, ADEM, pseudotumor cerebri, and optic neuritis, with an emphasis on the roles of venous vascular system programming and dysfunction in their pathogenesis. We consider the fundamental differences between arterial and venous endothelium, their dissimilar responses to inflammation, and the potential theoretical contributions of venous insufficiency in the pathogenesis of neurovascular diseases.
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Affiliation(s)
- Jonathan S Alexander
- Department of Molecular and Cellular Physiology, LSU Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130-3932, USA.
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Comi G, Battaglia MA, Bertolotto A, Del Sette M, Ghezzi A, Malferrari G, Salvetti M, Sormani MP, Tesio L, Stolz E, Zaratin P, Mancardi G. Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study. Mult Scler 2013; 19:1508-17. [PMID: 24014572 DOI: 10.1177/1352458513501231] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- G Comi
- Department of Neurology, Università Vita Salute San Raffaele, Milan, Italy
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No evidence for CCVSI in relapsing-remitting multiple sclerosis patients with moderate disability. J Neurol 2013; 260:2409-10. [DOI: 10.1007/s00415-013-7034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
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Quinn MP, Gati JS, Klassen ML, Lee DH, Kremenchutzky M, Menon RS. Increased deep gray matter iron is present in clinically isolated syndromes. Mult Scler Relat Disord 2013; 3:194-202. [PMID: 25878007 DOI: 10.1016/j.msard.2013.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 06/20/2013] [Accepted: 06/29/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Abnormal iron accumulation in MS has been known for decades, however it remains to be established whether iron reflects a cause or epiphenomenon of pathology. The objective of the present study is to determine if iron is increased in the brains of patients with clinically isolated syndromes (CIS) suggestive of early MS. METHODS Twenty-two patients with a CIS and 16 age- and sex-matched controls underwent 3T MRI studies. Differences in R2*, a metric of iron concentration, were assessed for all voxels throughout the brain. Similar clusters of significant differences were grouped, wherein mean R2* was regressed against a number of parameters, including extended disability status scale (EDSS), age, disease duration, and internal jugular vein (IJV) cross-sectional area (CSA), as measured from magnetic resonance time-of-flight venograms. RESULTS Patients had significantly increased R2* in globus pallidus, thalamus, right pulvinar, and cortical areas. Thalamic R2* correlated positively with EDSS. Decreased white matter R2* was detected at various positions in the patient group average. No correlations were found between any changes in R2* and IJV CSA. INTERPRETATION Iron is increased in CIS in deep gray matter, suggesting this iron accumulation, well-known in definite MS, occurs early in the disease course. Increases in thalamic iron are associated with worsened clinical status. Decreased white matter R2* may be interpreted as diffuse damage to normal appearing white matter, not often reported in CIS. Observations do not support a role for venous abnormalities in either iron accumulation or white matter damage.
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Affiliation(s)
- Matthew P Quinn
- Department of Medical Biophysics, The University of Western Ontario, Canada; Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, Canada
| | - Joseph S Gati
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, Canada
| | - Martyn L Klassen
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, Canada
| | - Donald H Lee
- Department of Medical Imaging, The University of Western Ontario, Canada
| | - Marcelo Kremenchutzky
- Department of Clinical Neurological Sciences, The University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, Ontario, Canada, N6A 5A5.
| | - Ravi S Menon
- Department of Medical Biophysics, The University of Western Ontario, Canada; Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, Canada
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Rahman MT, Sethi SK, Utriainen DT, Hewett JJ, Haacke EM. A comparative study of magnetic resonance venography techniques for the evaluation of the internal jugular veins in multiple sclerosis patients. Magn Reson Imaging 2013; 31:1668-76. [PMID: 23850076 DOI: 10.1016/j.mri.2013.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 04/24/2013] [Accepted: 05/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The use of magnetic resonance imaging (MRI) to assess the vascular nature of diseases such as multiple sclerosis (MS) is a growing field of research. This work reports on the application of MR angiographic (MRA) and venographic (MRV) techniques in assessing the extracranial vasculature in MS patients. MATERIALS AND METHODS A standardized MRI protocol containing 2D TOF-MRV and dynamic 3D contrast-enhanced (CE) MRAV was run for 170 MS patients and 40 healthy controls (HC). The cross-sectional area (CSA) of the internal jugular veins (IJVs) was measured at three neck levels in all subjects for both MRV techniques to determine the presence of venous stenoses. All data were analyzed retrospectively. RESULTS For the values where both methods showed signal, the 3D method showed larger CSA measurement values compared to 2D methods in both IJVs, in both MS and HC subjects which was confirmed with student paired t-tests. Of the 170 MS patients, 93 (55%) in CE-MRAV and 103 (61%) in TOF-MRV showed stenosis in at least one IJV. The corresponding numbers for the 40 HC subjects were 2 (5%) and 4 (10%), respectively. Carotid ectasias with IJV stenosis were seen in 26 cases (15%) with 3D CE-MRAV and were not observable with 2D TOF-MRV. Carotid ectasias were not seen in the HC group. In the 2D TOF-MRV data, banding of the IJVs related to slow flow was seen in 58 (34%) MS cases and in no HC cases. MS patients showed lower average CSAs than the HC subjects. CONCLUSION The 3D CE MRAV depicted the vascular anatomy more completely than the 2D TOF-MRV. However, the 3D CE MRAV does not provide any information about the flow characteristics which are indirectly available in the 2D TOF-MRV in those cases where there is slow flow.
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Prevalence of incidental narrowing of the superior segment of the internal jugular vein in patients without multiple sclerosis. Clin Neuroradiol 2013; 24:121-7. [PMID: 23817770 DOI: 10.1007/s00062-013-0232-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Internal jugular vein (IJV) narrowing superiorly is likely relatively frequent. IJV narrowing has been proposed as a potential pathophysiologic component for multiple sclerosis (MS). Our purpose was to investigate the prevalence of incidental superior IJV narrowing in patients imaged with neck computed tomography angiography (CTA) for reasons unrelated to IJV pathology or MS. METHODS We retrospectively identified 164 consecutive adult patients who had undergone neck CTA in which at least one IJV superior segment was opacified (158 right, 155 left IJVs). At the narrowest point of the upper IJV, each IJV was assessed for dominance, graded (shape and narrowing), measured (diameter and area), and located (axially and craniocaudally). Associations were analyzed using Spearman rank correlations (p < 0.05 significant). Medical records were reviewed for MS. RESULTS Among 164 patients, at least one IJV was: absent/pinpoint in 15 % (25/164), occluded/nearly occluded in 26 % (43/164). Shape, narrowing, and the three measurements all correlated with each other (all p < 0.01). Lateral location with respect to C1 transverse foramen correlated with subjectively and objectively smaller IJVs (p < 0.01). The most common craniocaudal location was at the C1 transverse process (79 % (125/158) of right and 81 % (126/155) of left IJVs). No patient had a diagnosis of MS. CONCLUSIONS The appearance of the superior IJV is variable, with an occlusive/near-occlusive appearance present in approximately one-quarter of patients without known MS undergoing CTA. Radiologists should be aware of and cautious to report or ascribe clinical significance to this frequent anatomic variant.
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Dolic K, Siddiqui AH, Karmon Y, Marr K, Zivadinov R. The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants. BMC Med 2013; 11:155. [PMID: 23806142 PMCID: PMC3699429 DOI: 10.1186/1741-7015-11-155] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/30/2013] [Indexed: 02/08/2023] Open
Abstract
The extra-cranial venous system is complex and not well studied in comparison to the peripheral venous system. A newly proposed vascular condition, named chronic cerebrospinal venous insufficiency (CCSVI), described initially in patients with multiple sclerosis (MS) has triggered intense interest in better understanding of the role of extra-cranial venous anomalies and developmental variants. So far, there is no established diagnostic imaging modality, non-invasive or invasive, that can serve as the "gold standard" for detection of these venous anomalies. However, consensus guidelines and standardized imaging protocols are emerging. Most likely, a multimodal imaging approach will ultimately be the most comprehensive means for screening, diagnostic and monitoring purposes. Further research is needed to determine the spectrum of extra-cranial venous pathology and to compare the imaging findings with pathological examinations. The ability to define and reliably detect noninvasively these anomalies is an essential step toward establishing their incidence and prevalence. The role for these anomalies in causing significant hemodynamic consequences for the intra-cranial venous drainage in MS patients and other neurologic disorders, and in aging, remains unproven.
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Affiliation(s)
- Kresimir Dolic
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High St, Buffalo, NY 14203, USA
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