Chronic cerebrospinal venous insufficiency in multiple sclerosis: a highly prevalent age-dependent phenomenon

Abstract

Background: This study aimed to investigate the prevalence and clinical relevance of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients and healthy controls using extra- and intracranial colour Doppler sonography.

Methods: We examined 146 MS patients, presenting with a clinically isolated syndrome, relapsing-remitting, secondary progressive, or primary progressive MS, and 38 healthy controls. Sonographic examination was performed according to Zamboni's protocol and was performed by three independent sonographers. The results of sonographic examination were compared with clinical and demographic characteristics of the patients.

Results: CCSVI, defined as the presence of at least two positive Zamboni's criteria, was found in 76% of MS patients and 16% of control subjects. B-mode anomalies of internal jugular veins, such as stenosis, malformed valves, annuli, and septa were the most common lesions detected in MS patients (80.8%) and controls (47.4%). We observed a positive correlation between sonographic diagnosis of CCSVI and the patients' age (p = 0.003). However, such a correlation was not found in controls (p = 0.635). Notably, no significant correlations were found between sonographic signs of CCSVI and clinical characteristics of MS, except for absent flow in the jugular veins, which was found more often in primary (p<0.005) and secondary (p<0.05) progressive patients compared with non-progressive patients. Absent flow in jugular veins was significantly correlated with patients' age (p < 0.0001).

Conclusions: Sonographically defined CCSVI is common in MS patients. However, CCSVI appears to be primarily associated with the patient's age, and poorly correlated with the clinical course of the disease.

Figure 1

Prevalence rates of Zamboni criteria and CCSVI for disease group (HC, MS) and MS subtype. ^aThe prevalence of CCSVI was significantly higher in the MS group than in the HC group (p<0.001). ^bThe absence of IJV and/or VV flow (Cr 4) was significantly more frequent in the PPMS form of disease compared with the RRMS form (p<0.005). ^cB-mode anomalies were the most frequently detected anomalies in MS patients and HCs. Abbreviations: CIS: clinically isolated syndrome; CCSVI: chronic cerebrospinal venous insufficiency; HCs: healthy controls; MS: multiple sclerosis; PPMS: primary progressive multiple sclerosis; RRMS: relapsing-remittent multiple sclerosis; SPMS: secondary progressive multiple sclerosis; Cr: Echo-Doppler criterion.