Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound--recommendations for a protocol.
2011
Chronic cerebrospinal venous insufficiency (CCSVI) is
a syndrome characterized by stenoses or obstructions
of the internal jugular and/or azygos veins with disturbed
flow and formation of collateral venous channels.
Ultrasound and venographic studies of the internal jugular and azygos venous systems in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 71%, range 0-100%; n=1336)associated with activation of collaterals. By contrast, ultrasound and venographic examinations of normal controls and patients without MS have demonstrated a much lower prevalence (mean 7.1%, range 0-22%; n=505).
Ultrasound in the form of duplex scanning uses a combination
of physiological measurements as well as anatomical imaging and has been used for the detection of CCSVI by different centers with variable results.
A high prevalence of obstructive lesions, ranging from
62% to 100%, has been found by some teams in patients
with MS compared with a low prevalence (0-25%) in controls. However, others have reported absence of these lesions or a lower prevalence (16-52%). This variability could be the result of differences in technique, training, experience or criteria used.
In order to ensure a high reproducibility of duplex scanning
with comparable accuracy between centers a detailed protocol with standard methodology and criteria
is needed. Also, standardization of the method of reporting
of duplex measurements and other findings will facilitate validation of the proposed criteria by different centers. The aim of this document is to produce recommendations
for such a protocol and indicate what future research is needed in order to address areas of uncertainty.
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