Chronic cerebrospinal venous insufficiency: Masked multimodal imaging assessment

Staley A. Brod, Larry A. Kramer, Alan M. Cohen, Andrew D. Barreto, Thanh Tung Bui, James R. Jemelka, Kelly Ton, John W. Lindsey, Flavia Nelson, Ponnada A. Narayana, Jerry S. Wolinsky

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Chronic cerebrospinal venous insufficiency (CCSVI) was implicated in the pathophysiology of multiple sclerosis (MS). Objective: We evaluated neurosonography (NS), magnetic resonance venography (MRV), and transluminal venography (TLV) in subsets of MS patients drawn from a single-center, prospective, case-control study of 206 MS and 70 non-MS volunteers. Methods: As previously reported, findings on high-resolution B-mode NS imaging with color and spectral Doppler of the extracranial and intracranial venous drainage consistent with CCSVI were similar among MS and non-MS volunteers (3.88% vs 7.14%; ρ = 0.266). Ninety-nine MS participants consented to intravascular contrast-enhanced 3D MRV to assess their major systemic and intracranial venous circulation, and 40 advanced to TLV that included pressure measurements of the superior vena cava, internal jugular, brachiocephalic, and azygous veins. Results: NS findings and MRV patterns were discrepant for 26/98 evaluable subjects, including four with abnormal findings on NS that had normal venous anatomy by MRV. In no instance were TLV pressure gradients indicative of clinically significant functional stenosis encountered. The three imaging approaches provided generally consistent data with discrepancies referable to inherent technique properties. Conclusions: Our findings lend no support for altered venous outflow dynamics as common among MS patients, nor do they likely contribute to the disease process.

Original languageEnglish (US)
Pages (from-to)1499-1507
Number of pages9
JournalMultiple Sclerosis Journal
Issue number11
StatePublished - Oct 2013


  • Multiple sclerosis
  • cerebral venous outflow
  • chronic cerebrospinal venous insufficiency
  • magnetic resonance venography
  • neurosonography
  • venography


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