To determine whether a correlation exists between chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS).
Materials and Methods:
A meta-analysis of the current literature was performed to evaluate the frequency of CCSVI, diagnosed by echo color Doppler criteria, in patients with MS and in normal controls.
Results:
In all, 19 studies were identified from January 2005 through February 2013; however, 3 studies were excluded due to duplicate data and 3 additional studies because 0 patients fulfilled CCSVI criteria in both MS and control groups. In order to improve homogeneity, 4 outlier studies were also removed from the analysis. Analysis of the remaining 9 studies demonstrated a significant correlation between CCSVI and MS (odds ratio 1.885, P < .0001) with no significant heterogeneity of the studies (I2 = 18, P = .279).
Conclusions:
The meta-analysis demonstrated a correlation between CCSVI and MS. However, there was no evidence that CCSVI has a causative role in MS.
TullmanMark J. Multiple Sclerosis. In: RileyClaire S., ed. Merritt's Neurology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 903–907.
2.
SospedraMMartinR. Immunology of multiple sclerosis. Annu Rev Immunol. 2005;23:683–747.
3.
ZamboniPGaleottiRMenegattiE. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009;80(4):392–399.
4.
BaracchiniCPeriniPCalbreseMCausinFRinaldiFGalloP. No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol. 2011;69(1):90–99.
5.
CentonzeDFlorisRStefaniniM. Proposed chronic cerebrospinal venous insufficiency criteria do not predict multiple sclerosis risk or severity. Annal Neurol. 2011;70(1):51–58.
6.
ChambersBChambersJCameronH, Macdonell R. Chronic cerebrospinal venous insufficiency is not more prevalent in patients with mild multiple sclerosis: a sonographer-blinded, case-control ultrasound study. Mult Scler. 2013;19(6):749–756.
LaupacisALillieEDueckA. Association between chronic cerebrospinal venous insufficiency and multiple sclerosis: a meta-analysis. CMAJ. 2011;183(16):E1203–E1212.
9.
MorovicSZamboniP. CCSVI is associated with multiple sclerosis. Neurol Res. 2012;34(8):770–779.
10.
LanzilloRManciniMLiuzziR. Chronic cerebrospinal venous insufficiency in multiple sclerosis: a highly prevalent age-dependent phenomenon. BMC Neurol. 2013;13:20.
11.
ZamboniPMorovicSMenegattiEViselnerGNicolaidesAN. Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound—recommendations for a protocol. Int Angiol. 2011;30(6):571–597.
12.
GhezziAAnnovazziPCoccoE. Endovascular treatment of CCSVI in patients with multiple sclerosis: clinical outcome of 462 cases [Published online January 25, 2013]. Neurol Sci.
13.
DolicKMarrKValnarovV. Sensitivity and specificity for screening of chronic cerebrospinal venous insufficiency using a multimodal non-invasive imaging approach in patients with multiple sclerosis. Funct Neurol. 2011;26(4):205–214.
14.
PattiFNicolettiALeoneC. Multiple sclerosis and CCSVI: a population-based case control study. Plos One. 2012;7(8):e41227.
15.
FlorisRCentonzeDFabianoS. Prevalence study of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis: preliminary data. Radiol Med. 2012;117(5):855–864.
16.
DoeppFHoffmannOSchreiberSLammertIEinhäuplKMValduezaJM. Venous collateral blood flow assessed by doppler ultrasound after unilateral radical neck dissection. Ann Otol Rhinol Laryngol. 2001;110(11):1055–1058.
17.
BlinkenbergMAkesonPSillesenH. Chronic cerebrospinal venous insufficiency and venous stenoses in multiple sclerosis. Acta Neurol Scand. 2012;126(6):421–427.
18.
McAuliffeWKermodeAG. Mystery of chronic cerebrospinal venous insufficiency: identical venographic and ultrasound findings in patients with MS and controls. Am J Neuroradiol. 2013;34(7):1370–1374.
19.
ZamboniPMenegattiEWeinstock-GuttmanB. The severity of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis is related to altered cerebrospinal fluid dynamics. Funct Neurol. 2009;24(3):133–138.
20.
Al-OmariMHRousanLA. Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis. Int Angiol. 2010;29(2):115–120.
21.
KrogiasCSchroderAWiendlHHohlfeldRGoldR. Chronic cerebrospinal venous insufficiency and multiple sclerosis: critical analysis and first observation in an unselected cohort of MS patients. Nervenart. 2010;81(6):740–746.
22.
MayerCAPfeilschifterWLorenzMW. The perfect crime? CCSVI not leaving a trace in MS. JNNP. 2011;82(4):436–440.
23.
ZivadinovRCutterGMarrK. No association between conventional brain MR imaging and chronic cerebrospinal venous insufficiency in multiple sclerosis. AJNR Am JH Neuroradiol. 2012;33(10):1913–1917.
Van den BergPJVan den BergGBWesterhuisLWVisserLH. Occurrence of CCSVI in patients with MS and its relationship with iron metabolism and varicose veins. Eur J Neurol. 2013;20(3):519–526.
26.
LeoneMARaymkulovaONaldiP. Chronic cerebrospinal venous insufficiency is not associated with multiple sclerosis and its severity: a blind-verified study. Plos One. 2013;8(2):e56031.
27.
ImperialeDMelisFGiacconeC. Chronic cerebrospinal venous insufficiency in multiple sclerosis: a sonographer-blinded case-control study. Clin Neurol Neurosurg. 2013;115(8):1394–1398.
28.
SimkaMLudygaTLataczPKazibudzkiM. Diagnostic accuracy of current sonographic criteria for the detection of outflow abnormalities in the internal jugular veins. Phlebology. 2013;28(6):285–292.
29.
ScaliseFFarinaMManfrediMAuguadroCNovelliE. Assessment of jugular endovascular malformations in chronic cerebrospinal venous insufficiency: colour-Doppler scanning and catheter venography compared with intravascular ultrasound[Published online November 15, 2012]. Phlebology. 2012.
30.
AkkawiNMAgostiCBorroniB. Jugular valve incompetence: a study using air contrast ultrasonography on a general population. J Ultrasound Med. 2002;21(7):747–751.
31.
KakalachevaKLunemannJD. Environmental triggers of multiple sclerosis. FEBS Lett. 2011;585(23):3724–3729.
32.
ZamboniPBertolottoABoldriniP. Efficacy and safety of venous angioplasty of the extracranial veins for multiple sclerosis. Brave dreams study (brain venous drainage exploited against multiple sclerosis): study protocol for a randomized controlled trial. Trials. 2012;13:183.
