Value of MR venography for detection of internal jugular vein anomalies in multiple sclerosis: a pilot longitudinal study

Abstract

Background and purpose: CCSVI was recently described in patients with MS. CCSVI is diagnosed noninvasively by Doppler sonography and invasively by catheter venography. We assessed the role of conventional MRV for the detection of IJV anomalies in patients with MS diagnosed with CCSVI and in healthy controls who underwent MRV and Doppler sonography examinations during 6 months.

Materials and methods: Ten patients with MS underwent TOF, TRICKS, Doppler sonography, and catheter venography at baseline. They were treated at baseline with percutaneous angioplasty and re-evaluated 6 months' posttreatment with MRV and Doppler sonography. In addition, 6 healthy controls underwent a baseline and a 6-month follow-up evaluation by Doppler sonography and MRV.

Results: At baseline, the sensitivity, specificity, PPV, and NPV of Doppler sonography for detecting IJV abnormalities relative to catheter venography in patients with MS were calculated, respectively, at 82%, 100%, 99%, and 95%. The figures were 99%, 33%, 33%, 99% for TOF and 99%, 39%, 35%, and 99% for TRICKS. Venous anomalies included the annulus, septum, membrane, and malformed valve. No agreement was found between TOF and catheter venography in 70% of patients with MS and between TRICKS and catheter venography in 60% of patients with MS. At follow-up, 50% of the patients with MS presented with abnormalities on Doppler sonography but only 30% were diagnosed with restenosis.

Conclusions: Conventional MRV has limited value for assessing IJV anomalies for both diagnostic and posttreatment purposes.

Fig 1.

Patient with MS (a 43-year-old woman) shows normal examination findings on TOF (A) and TRICKS (B) of both IJVs pretreatment. C, Doppler sonography shows the presence of a septum (arrow) in the right IJV (upper image) and an annulus (arrow) in the left IJV (lower image). D−F, Catheter venography (D) confirms the presence of a septum (arrow) in the right IJV and an annulus (arrow) in the left IJV. The posttreatment 6-month follow-up shows normal examination findings on TOF (E), TRICKS (F), and Doppler sonography (G).

Fig 2.

Patient with MS (a 44-year-old man) has normal examination findings on TOF (A) and TRICKS (B) of both IJVs pretreatment. C, Doppler sonography shows the presence of stenoses in the right IJV (arrow, upper image) and in the left IJV (arrow, lower image). D, Catheter venography confirms the presence of stenosis (arrows) in the right IJV and in the left IJV. E–G, The posttreatment 6-month follow-up shows normal examination findings on TOF (E) and TRICKS (F), but no change in the stenosis (arrows) on Doppler sonography (G) in the right IJV (upper image) and in the left IJV (lower image).

Fig 3.

Variability between the baseline (A, C, and E, TOF, TRICKS, and Doppler sonography, respectively) and follow-up (B, D, and F, TOF, TRICKS, and Doppler sonography, respectively) examinations in a 42-year-old healthy female control. Flattening of the left IJV (arrows) at follow-up is noted on the TOF (B) and TRICKS (D), whereas Doppler sonography shows normal examination findings like those at baseline (F).

Fig 4.

Variability between the baseline (A, C, and E, TOF, TRICKS, and Doppler sonography, respectively) and follow-up (B, D, and F, TOF, TRICKS and Doppler sonography, respectively) examinations in a 39-year-old healthy male control. Flattening of the right IJV (arrows) present at the baseline (A and C) examination is not present at follow-up (B and D). Doppler sonography examination shows normal findings at baseline (E) and follow-up (F).