Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS

• Published in: Neurology Vol. 77; no. 2; pp. 138 - 144
• Main Authors: ZIVADINOV, R, MARR, K, HUNT, K, ANDREWS, M, CARL, E, DWYER, M. G, HOJNACKI, D, WEINSTOCK-GUTTMAN, B, CUTTER, G, RAMANATHAN, M, BENEDICT, R. H. B, KENNEDY, C, ELFADIL, M, YEH, A. E, REUTHER, J, BROOKS, C
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 12-07-2011
• Subjects: Adult; Aged; Biological and medical sciences; Chronic Disease; Cohort Studies; Cross-Sectional Studies; Disability Evaluation; Echocardiography, Doppler, Color - methods; Female; Humans; Male; Medical sciences; Middle Aged; Multiple Sclerosis - epidemiology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Prevalence; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Venous Insufficiency - diagnosis; Venous Insufficiency - epidemiology; Vascular disease; Chronic; Nervous system diseases; Sensitivity; Specificity; Prevalence; Cardiovascular disease; Venous incompetence; Venous disease; Varix
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0b013e318212a901

Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in patients with multiple sclerosis (MS). A subject is considered CCSVI positive if ≥ 2 venous hemodynamic (VH) criteria are fulfilled.
To determine prevalence of CCSVI in a large cohort of patients with MS, clinically isolated syndrome (CIS), other neurologic diseases (OND), and healthy controls (HC), using specific proposed echo-color Doppler (ECD) criteria.
Transcranial and extracranial ECD were carried out in 499 enrolled subjects (289 MS, 163 HC, 26 OND, 21 CIS). Prevalence rates for CCSVI were calculated in 3 ways: first, using only the subjects for whom diagnosis was certain (i.e., borderline subjects were excluded); secondly, including the borderline subjects in the "no CCSVI" group; and finally, taking into account subjects who presented any of the VH criteria.
CCSVI prevalence with borderline cases included in the "no CCSVI" group was 56.1% in MS, 42.3% in OND, 38.1% in CIS, and 22.7% in HC (p < 0.001). The CCSVI prevalence figures were 62.5% for MS, 45.8% for OND, 42.1% for CIS, and 25.5% for HC when borderline cases were excluded (p < 0.001). The prevalence of one or more positive VH criteria was the highest in MS (81.3%), followed by CIS (76.2%), OND (65.4%), and HC (55.2%) (p < 0.001). CCSVI prevalence was higher in patients with progressive than in nonprogressive MS (p = 0.004).
Our findings are consistent with an increased prevalence of CCSVI in MS but with modest sensitivity/specificity. Our findings point against CCSVI having a primary causative role in the development of MS.