Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound - Recommendations for a protocol

• Published in: International angiology Vol. 30; no. 6; pp. 571 - 597
• Main Authors: ZAMBONI, P, MOROVIC, S, MENEGATTI, E, VISELNER, G, NICOLAIDES, A. N
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Torino Minerva Medica 01.12.2011
• Subjects: Azygos Vein - diagnostic imaging; Azygos Vein - physiopathology; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Cerebrovascular Circulation; Cerebrovascular Disorders - diagnostic imaging; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - physiopathology; Chronic Disease; Collateral Circulation; Constriction, Pathologic; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Humans; Investigative techniques, diagnostic techniques (general aspects); Jugular Veins - diagnostic imaging; Jugular Veins - physiopathology; Mass Screening - methods; Mass Screening - standards; Medical sciences; Multiple Sclerosis - diagnostic imaging; Multiple Sclerosis - epidemiology; Multiple Sclerosis - physiopathology; Observer Variation; Predictive Value of Tests; Prevalence; Prognosis; Reproducibility of Results; Spinal Cord - blood supply; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex - standards; Venous Insufficiency - diagnostic imaging; Venous Insufficiency - epidemiology; Venous Insufficiency - physiopathology; Venous insufficiency; Cardiovascular disease; Venous incompetence; Constriction, pathologic; Medical screening; Recommendation; Venous disease; Vascular disease; Chronic; Echography; Ultrasonography; Ultrasound; Varix
• ISSN: 0392-9590; 1827-1839

Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses or obstructions of the internal jugular and/or azygos veins with disturbed flow and formation of collateral venous channels. Studies using ultrasound in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 70%; range 0-100%; N.=1496), whereas, in normal controls and patients without MS the prevalence was much lower (mean 10%; range 0-36%; N.=635). Ultrasound uses a combination of physiological measurements as well as anatomical imaging and has been used for the detection of CCSVI by different centers with variable results. A high prevalence ranging from 62% to 100% of obstructive lesions has been found by some teams in patients with MS compared with a lower prevalence of 0-25% in controls. However, absence of such lesions or a lower prevalence (16-52%) has been reported by others. This variability could be the result of differences in technique, training, experience or criteria used. The current lack of a methodology shared among experts is a confounding element in epidemiologic studies, and does not permit further Bayesan or other kind of analysis. In order to ensure a high reproducibility of Duplex scanning with comparable accuracy between centers, a detailed protocol with standard methodology and criteria is proposed. This is also necessary for training. It has been shown that inter-rater variability increases post-training (from k=0.47 to k=0.80), while within-rater reproducibility in trained operators was k=0.75. Finally, the consensus document proposes a reporting standard of Duplex measurements, and future research to answer areas of uncertainty.