Jugular Venous Flow Abnormalities in Multiple Sclerosis Patients Compared to Normal Controls

Abstract

Background: To determine if extracranial venous structural and flow abnormalities exist in patients with multiple sclerosis (MS).

Methods: Magnetic resonance imaging was used to assess the anatomy and function of major veins in the neck in 138 MS patients and 67 healthy controls (HC). Time-of-flight MR angiography (MRA) was used to assess stenosis while 2-dimensional phase-contrast flow quantification was used to assess flow at the C2/C3 and C5/C6 levels. Venous flow was normalized to the total arterial flow. The MS patients were divided into stenotic (ST) and nonstenotic (NST) groups based on MRA assessment, and each group was compared to the HC group in anatomy and flow.

Results: The MS group showed lower normalized internal jugular vein (IJV) blood flow (tIJV/tA) than the HC group (P < .001). In the MS group, 72 (52%) were classified as ST while 66 (48%) were NST. In the HC group, 11 (23%) were ST while 37 (77%) were NST. The ST-MS group had lower IJV flow than both HC and NST-MS groups.

Conclusion: After categorizing the MS population into two groups based upon anatomical stenosis, as determined from an absolute quantification of IJV cross section, clear differences in IJV flow between the ST-MS and HC samples became evident. Despite the unknown etiology of MS, abnormal venous flow was noted in a distinct group of MS patients compared to HC.

Keywords: Venous flow; flow quantification; phase-contrast MRI; stenosis; vessel cross-sectional areas.

Figure 1

2D TOF MRV (A–C) 3D CE TWIST MRAV (D–H). CE images were chosen at the time point where the veins appear the brightest. Top row: HC (A–D); bottom row: MS patients (E–H). Various venous abnormalities are noted. Image A shows a stenotic RIJV in the upper and lower neck levels, as well as a stenotic LIJV in the lower neck level. Image B shows a stenotic case, where the CFV branches off at a low level of the neck which would reduce the IJV caliber Images C and D are without anomaly but one individual has clear external jugulars (C) while the other does not (D). Image E shows an aplastic RIJV, the LIJV is present (arrow). Image F shows upper neck level stenosis of the RIJV (upper left arrow), and atresia of the LIJV between the arrows. Image G shows an aplastic LIJV, RIJV is present (arrow). Image H shows multiple atresias in the LIJV (arrows).

Figure 2

a) Plot of right versus left C2/C3 normalized IJV flow. b) Plot of right versus left C5/C6 normalized IJV flow. c) IJV flow normalized to arterial flow for the C5/C6 neck level plotted against the C2/C3 neck level. Legend: triangles: HC; open circles: NST-MS; and plus signs: ST-MS. Threshold lines of Fijv/TA at C6 < 0.62 and Fijv/TA atC2 < 0.66 are drawn (dotted lines).

Figure 3

a) Comparison of mean flow (mL/min) between MS and HC groups at both the C2/C3 and C5/C6 neck levels for LIJV, RIJV and total IJV flow (one standard deviation error bars of the population distribution are shown). This plot is an attempt to replicate the data from the study by Rodger and colleagues [23]. b) Comparison of mean flow between the ST-MS group, NST-MS group, and HC group at both C2/C3 and C5/C6 neck levels for LIJV, RIJV and total IJV flow. In this chart, the bars represent the standard error of the mean. As discussed in the text, there are significant differences between the ST-MS group and the HC for total IJV flow.

Figure 4

Histogram of RIJV and LIJV for MS and HC groups showing the percentage of those samples within the given CSA ranges. This data set comes from the C5/C6 neck level using 2D TOF MRV (and if no signal was present, then the 3D CE MRAV was used). There are 48 cases here as 19 did not have venography collected.