Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS

• Published in: Neurology Vol. 77; no. 2; p. 138
• Main Authors: Zivadinov, R, Marr, K, Cutter, G, Ramanathan, M, Benedict, R H B, Kennedy, C, Elfadil, M, Yeh, A E, Reuther, J, Brooks, C, Hunt, K, Andrews, M, Carl, E, Dwyer, M G, Hojnacki, D, Weinstock-Guttman, B
• Format: Journal Article
• Language: English
• Published: United States 12.07.2011
• Subjects: Adult; Aged; Chronic Disease; Cohort Studies; Cross-Sectional Studies; Disability Evaluation; Echocardiography, Doppler, Color - methods; Female; Humans; Male; Middle Aged; Multiple Sclerosis - epidemiology; Prevalence; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Venous Insufficiency - diagnosis; Venous Insufficiency - epidemiology
• DOI: 10.1212/WNL.0b013e318212a901

Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in patients with multiple sclerosis (MS). A subject is considered CCSVI positive if ≥ 2 venous hemodynamic (VH) criteria are fulfilled. To determine prevalence of CCSVI in a large cohort of patients with MS, clinically isolated syndrome (CIS), other neurologic diseases (OND), and healthy controls (HC), using specific proposed echo-color Doppler (ECD) criteria. Transcranial and extracranial ECD were carried out in 499 enrolled subjects (289 MS, 163 HC, 26 OND, 21 CIS). Prevalence rates for CCSVI were calculated in 3 ways: first, using only the subjects for whom diagnosis was certain (i.e., borderline subjects were excluded); secondly, including the borderline subjects in the "no CCSVI" group; and finally, taking into account subjects who presented any of the VH criteria. CCSVI prevalence with borderline cases included in the "no CCSVI" group was 56.1% in MS, 42.3% in OND, 38.1% in CIS, and 22.7% in HC (p < 0.001). The CCSVI prevalence figures were 62.5% for MS, 45.8% for OND, 42.1% for CIS, and 25.5% for HC when borderline cases were excluded (p < 0.001). The prevalence of one or more positive VH criteria was the highest in MS (81.3%), followed by CIS (76.2%), OND (65.4%), and HC (55.2%) (p < 0.001). CCSVI prevalence was higher in patients with progressive than in nonprogressive MS (p = 0.004). Our findings are consistent with an increased prevalence of CCSVI in MS but with modest sensitivity/specificity. Our findings point against CCSVI having a primary causative role in the development of MS.