The sonographic findings of chronic cerebrospinal venous insufficiency (CCSVI) are used by some as selection criteria for venography. We performed a systematic review to establish the prevalence and strength of association between sonographic CCSVI and multiple sclerosis (MS).
Method
Two reviewers searched PubMed and EMBASE from 1948 to date using the keywords ‘chronic cerebrospinal venous insufficiency’ according to PRISMA guidelines.
Results
Four cross-sectional studies met the criteria for inclusion. The prevalence of CCSVI ranged from 7% to 100% in MS patients and from 2% to 36% in healthy controls. Diagnostic odds ratios for MS varied between 2 and 26, 499 (I2 = 94%). Sensitivities of CCSVI for MS varied between 7% and 100% (I2 = 98%). Specificities varied between 64% and 100% (I2 = 95%).
Conclusion
There is substantial variation in the strength of association between CCSVI and MS beyond that explained by demographic differences or sonographer training. Reliable evidence on which to base decisions requires sonographic consensus and assessment of the reproducibility of individual criteria between trained sonographers.
ZamboniP. The big idea: iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis. J R Soc Med2006;99:589–93
2.
ZamboniP, GaleottiR, MenegattiE, Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry2009;80:392–9
3.
MayerCA, PfeilschifterW, LorenzMW, The perfect crime? CCSVI not leaving a trace in MS. J Neurol Neurosurg Psychiatry2011;82:436–40
4.
DoeppF, PaulF, ValduezaJM, SchmiererK, SchreiberSJ. No cerebrocervical venous congestion in patients with multiple sclerosis. Ann Neurol2010;68:173–83
5.
ReekersJA, LeeMJ, BelliAM, BarkhofF. Cardiovascular and Interventional Radiological Society of Europe commentary on the treatment of chronic cerebrospinal venous insufficiency. Cardiovasc Intervent Radiol2011;34:1–2
6.
ZamboniP, GaleottiR, Weinstock-GuttmanB, KennedyC, SalviF, ZivadinovR. Venous angioplasty in patients with multiple sclerosis: results of a pilot study. Eur J Vasc Endovasc Surg2011Aug 10 [Epub ahead of print]
7.
ThaparA, LaneTR, PandeyV, Internal jugular thrombosis post venoplasty for chronic cerebrospinal venous insufficiency. Phlebology2011;26:254–6
8.
SamsonK. Experimental multiple sclerosis vascular shunting procedure halted at Stanford. Ann Neurol2010;67:A13–5
9.
PolmanCH, ReingoldSC, EdanG, Diagnostic criteria for multiple sclerosis: 2005 revisions to the ‘McDonald Criteria’. Ann Neurol2005;58:840–6
KrogiasC, SchroderA, WiendlH, HohlfeldR, GoldR. [‘Chronic cerebrospinal venous insufficiency’ and multiple sclerosis: critical analysis and first observation in an unselected cohort of MS patients]. Nervenarzt2010;81:740–6
12.
BossuytPM, ReitsmaJB, BrunsDE, [Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.] Dtsch Med Wochenschr2011;136:e24
13.
HigginsJP, ThompsonSG. Quantifying heterogeneity in a meta-analysis. Stat Med2002;21:1539–58
14.
ZamboniP, MenegattiE, GaleottiR, The value of cerebral Doppler venous haemodynamics in the assessment of multiple sclerosis. J Neurol Sci2009;282:21–7
15.
CentonzeD, FlorisR, StefaniniM, Proposed chronic cerebrospinal venous insufficiency criteria do not predict multiple sclerosis risk or severity. Ann Neurol2011;70:52–9
16.
ZivadinovR, MarrK, CutterG, Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS. Neurology2011;77:138–44
17.
HojnackiD, ZamboniP, Lopez-SorianoA, Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls. Int Angiol2010;29:127–39
18.
MenegattiE, GenovaV, TessariM, The reproducibility of colour Doppler in chronic cerebrospinal venous insufficiency associated with multiple sclerosis. Int Angiol2010;29:121–6
19.
Al-OmariMH, RousanLA. Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis. Int Angiol2010;29:115–20
20.
TsivgoulisG, MantatzisM, BogiatziC, Extracranial venous hemodynamics in multiple sclerosis: a case-control study. Neurology2011Aug 24 [Epub ahead of print]
21.
BaracchiniC, PeriniP, CausinF, CalabreseM, RinaldiF, GalloP. Progressive multiple sclerosis is not associated with chronic cerebrospinal venous insufficiency. Neurology2011;77:844–50
22.
BownMJ, SuttonAJ. Quality control in systematic reviews and meta-analyses. Eur J Vasc Endovasc Surg2010;40:669–77
23.
OatesCP, NaylorAR, HartshorneT, Joint recommendations for reporting carotid ultrasound investigations in the United Kingdom. Eur J Vasc Endovasc Surg2009;37:251–61
24.
TouboulPJ, HennericiMG, MeairsS, Mannheim carotid intima-media thickness consensus (2004–2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis2007;23:75–80
25.
Bradford HillA. The environment and disease: association or causation?Proc RSM1965;58:295–300
26.
BaracchiniC, PeriniP, CalabreseM, CausinF, RinaldiF, GalloP. No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol2011;69:90–9
27.
Meyer-SchwickerathR, HaugC, HackerA, Intracranial venous pressure is normal in patients with multiple sclerosis. Mult Scler2011;17:637–8
28.
ArhartRW. A possible haemodynamic mechanism for amyotrophic lateral sclerosis. Med Hypotheses2010; 75:341–6
29.
ChungCP, HsuHY, ChaoAC, ChengCY, LinSJ, HuHH. Jugular venous reflux affects ocular venous system in transient monocular blindness. Cerebrovasc Dis2010;29:122–9
30.
CejasC, CisnerosLF, LagosR, ZukC, AmerisoSF. Internal jugular vein valve incompetence is highly prevalent in transient global amnesia. Stroke2010;41: 67–71
31.
NedelmannM, KapsM, Mueller-ForellW. Venous obstruction and jugular valve insufficiency in idiopathic intracranial hypertension. J Neurol2009;256:964–9
