Venous Multiple Sclerosis Hypothesis | CCSVI

• [zivadinov11a] Zivadinov R, Galeotti R, Hojnacki D, Menegatti E, Dwyer MG, Schirda C, Malagoni AM, Marr K, Kennedy C, Bartolomei I, Magnano C, Salvi F, Weinstock-Guttman B, and Zamboni P: Value of MR Venography for Detection of Internal Jugular Vein Anomalies in Multiple Sclerosis: A Pilot Longitudinal Study. AJNR Am J Neuroradiol. 2011 Apr:. PMID 21474626, doi:10.3174/ajnr.A2386. PDF.
  Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, New York; Jacobs Neurological Institute, State University of New York, Buffalo, New York; and Vascular Diseases Center, University of Ferrara-Bellaria Neurosciences, Ferrara and Bologna, Italy.
  Abstract

  BACKGROUND AND PURPOSE: CCSVI was recently described in patients with MS. CCSVI is diagnosed noninvasively by Doppler sonography and invasively by catheter venography. We assessed the role of conventional MRV for the detection of IJV anomalies in patients with MS diagnosed with CCSVI and in healthy controls who underwent MRV and Doppler sonography examinations during 6 months. MATERIALS AND METHODS: Ten patients with MS underwent TOF, TRICKS, Doppler sonography, and catheter venography at baseline. They were treated at baseline with percutaneous angioplasty and re-evaluated 6 months' posttreatment with MRV and Doppler sonography. In addition, 6 healthy controls underwent a baseline and a 6-month follow-up evaluation by Doppler sonography and MRV. RESULTS: At baseline, the sensitivity, specificity, PPV, and NPV of Doppler sonography for detecting IJV abnormalities relative to catheter venography in patients with MS were calculated, respectively, at 82%, 100%, 99%, and 95%. The figures were 99%, 33%, 33%, 99% for TOF and 99%, 39%, 35%, and 99% for TRICKS. Venous anomalies included the annulus, septum, membrane, and malformed valve. No agreement was found between TOF and catheter venography in 70% of patients with MS and between TRICKS and catheter venography in 60% of patients with MS. At follow-up, 50% of the patients with MS presented with abnormalities on Doppler sonography but only 30% were diagnosed with restenosis. CONCLUSIONS: Conventional MRV has limited value for assessing IJV anomalies for both diagnostic and posttreatment purposes.

• [zamboni11a] Zamboni P, and Carinci F: Face, brain, and veins: a new perspective for multiple sclerosis onset. J Craniofac Surg. 2011 Jan;22(1):376. PMID 21239945, doi:10.1097/SCS.0b013e3181f81652.
  1Vascular Disease Center, University of Ferrara, Ferrara, Italy 2Maxillofacial Surgery, University of Ferrara, Ferrara, Italy.
• [zivadinov10b] Zivadinov R, Lopez-Soriano A, Weinstock-Guttman B, Schirda CV, Magnano CR, Dolic K, Kennedy CL, Brooks CL, Reuther JA, Hunt K, Andrews M, Dwyer MG, and Hojnacki DW: Use of MR Venography for Characterization of the Extracranial Venous System in Patients with Multiple Sclerosis and Healthy Control Subjects. Radiology. 2010 Dec:. PMID 21177394, doi:10.1148/radiol.10101387.
  Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, State University of New York, 100 High St., Buffalo, NY 14203.
  Abstract

  Purpose: To investigate the differences in the extracranial venous system in patients with multiple sclerosis (MS) and healthy control (HC) subjects by using magnetic resonance (MR) venography. Materials and Methods: This HIPAA-compliant, prospective study was approved by the local institutional review board, and all participants gave informed consent. Fifty-seven patients, 41 (72%) with relapsing-remitting MS and 16 (28%) with secondary-progressive MS, and 21 HC subjects were imaged with a 3-T MR unit by using two-dimensional (2D) time-of-flight (TOF) and three-dimensional (3D) time-resolved imaging of contrast kinetics (TRICKS) sequences. In addition, six MS patients and six HC subjects underwent two sequential MR venographic examinations during 1 week to test image-reimage reproducibility. The morphologic features of internal jugular vein flow were classified as absent, pinpoint, flattened, crescentic, or ellipsoidal flow. Only absent and pinpoint flow were considered abnormal. The flow of the vertebral veins was classified as absent or present. The prominence of collateral neck veins and venous asymmetries between the left and right sides were assessed. Differences among groups were tested with a two-tailed Mann-Whitney two-sample rank-sum test. Results: No significant differences in morphologic features of flow in the internal jugular veins and vertebral veins were found between MS patients and HC subjects in any of the examined MR venographic parameters. No differences in asymmetry or prominence were found between MS patients and HC subjects. There was modest agreement (κ = 0.67) between 2D TOF and 3D TRICKS sequences. Image-reimage reproducibility showed modest agreement (κ = 0.66) for 2D TOF and low agreement for 3D TRICKS (κ = 0.33). Conclusion: No significant differences in the extracranial venous systems between MS patients and HC subjects were detected by using MR venography. Standardized guidelines are needed to define parameters for the presence of venous anomalies.

On April 14^th, the MS Society and the American Academy of Neurology will hold a live web forum about CCSVI and MS. Anyone can attend.

Update: Online viewer for all who have missed the live webcast

This webcast takes place while the American Academy of Neurology (AAN) Annual Meeting, Toronto, 10–17 Apr 2010.

The 2010 April;29(2) issue of International Angiology Journal is dedicated to CCSVI and contains 13 articles. Another article appeared in Neurology.

1. [zamboni10c] Zamboni P: Chronic cerebrospinal venous insufficiency. Int Angiol. 2010 Apr;29(2):91-2. PMID 20351663. PDF , Article$.
   Vascular Diseases Center, University of Ferrara, Ferrara, Italy
2. [embry10a] Embry AF: Integrating CCSVI and CNS autoimmunity in a disease model for MS. Int Angiol. 2010 Apr;29(2):93-4. PMID 20351664. PDF , Article$
   Direct-MS, Calgary, AL, Canada
3. [lee10a] Lee AB, Laredo J, and Neville R: Embryological background of truncular venous malformation in the extracranial venous pathways as the cause of chronic cerebro spinal venous insufficiency. Int Angiol. 2010 Apr;29(2):95-108. PMID 20351665. PDF , Article$.
   Department of Vascular Surgery, Georgetown University Hospital, Washington DC, USA.
4. [simka10b] Simka M, Kostecki J, Zaniewski M, Majewski E, and Hartel M: Extracranial Doppler sonographic criteria of chronic cerebrospinal venous insufficiency in the patients with multiple sclerosis. Int Angiol. 2010 Apr;29(2):109-14. PMID 20351666. PDF , Article$
   Department of Angiology, Private Healthcare Institution SANA, Pszczyna, Poland
5. [al-omari10a] Al-Omari MH, and Rousan LA: Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis. Int Angiol. 2010 Apr;29(2):115-20. PMID 20351667. PDF , Article$.
   Radiology Department, King Abdullah University Hospital, Jordan University of Science and Technology, Jordan.
6. [menegatti10a] Menegatti E, Genova V, Tessari M, Malagoni AM, Bartolomei I, Zuolo M, Galeotti R, Salvi F, and Zamboni P: The reproducibility of colour Doppler in chronic cerebrospinal venous insufficiency associated with multiple sclerosis. Int Angiol. 2010 Apr;29(2):121-6. PMID 20351668. PDF , Article$.
   Vascular Diseases Centre, University of Ferrara, Italy
7. [hojnacki10a] Hojnacki D, Zamboni P, Lopez-Soriano A, Galleotti R, Menegatti E, Weinstock-Guttman B, Schirda C, Magnano C, Malagoni AM, Kennedy C, Bartolomei I, Salvi F, and Zivadinov R: Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls. Int Angiol. 2010 Apr;29(2):127-39. PMID 20351669. PDF , Article$.
   The Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA
8. [zamboni10b] Zamboni P, Menegatti E, Weinstock-Guttman B, Schirda C, Cox JL, Malagoni AM, Hojnacki D, Kennedy C, Carl E, Dwyer MG, Bergsland N, Galeotti R, Hussein S, Bartolomei I, Salvi F, Ramanathan M, and Zivadinov R: CSF dynamics and brain volume in multiple sclerosis are associated with extracranial venous flow anomalies: a pilot study. Int Angiol. 2010 Apr;29(2):140-8. PMID 20351670. PDF , Article$.
   Vascular Diseases Center, University of Ferrara-Bellaria Neurosciences, Ferrara and Bologna, Italy
9. [haacke10a] Haacke EM, Garbern J, Miao Y, Habib C, and Liu M: Iron stores and cerebral veins in MS studied by susceptibility weighted imaging. Int Angiol. 2010 Apr;29(2):149-57. PMID 20351671. PDF , Article$.
   Department of Radiology, Wayne State University, Detroit, MI, USA; Department of Radiology, the First Affiliated Hospital, Dalian Medical University, Dalian, China
10. [zivadinov10a] Zivadinov R, Schirda C, Dwyer MG, Haacke ME, Weinstock-Guttman B, Menegatti E, Heininen-Brown M, Magnano C, Malagoni AM, Wack DS, Hojnacki D, Kennedy C, Carl E, Bergsland N, Hussein S, Poloni G, Bartolomei I, Salvi F, and Zamboni P: Chronic cerebrospinal venous insufficiency and iron deposition on susceptibility-weighted imaging in patients with multiple sclerosis: a pilot case-control study. Int Angiol. 2010 Apr;29(2):158-75. PMID 20351672. PDF , Article$.
    Buffalo Neuroimaging Analysis Center, University at Buffalo, Buffalo, NY, USA
11. [malagoni10a] Malagoni AM, Galeotti R, Menegatti E, Manfredini F, Basaglia N, Salvi F, and Zamboni P: Is chronic fatigue the symptom of venous insufficiency associated with multiple sclerosis? A longitudinal pilot study. Int Angiol. 2010 Apr;29(2):176-82. PMID 20351673. PDF , Article$.
    Vascular Diseases Center, University of Ferrara, Ferrara, Italy
12. [bartolomei10a] Bartolomei I, Salvi F, Galeotti R, Salviato E, Alcanterini M, Menegatti E, Mascalchi M, and Zamboni P: Hemodynamic patterns of chronic cerebrospinal venous insufficiency in multiple sclerosis. Correlation with symptoms at onset and clinical course. Int Angiol. 2010 Apr;29(2):183-8. PMID 20351674. PDF , Article$.
    Center for Rare and Neuroimmunitary Diseases, Department of Neurological Science, Bellaria Hospital, Bologna, Italy
13. [plasmati10a] Plasmati R, Pastorelli F, Fini N, Salvi F, Galeotti R, and Zamboni P: Chronic cerebro-spinal venous insufficiency: report of transcranial magnetic stimulation follow-up study in a patient with multiple sclerosis. Int Angiol. 2010 Apr;29(2):189-92. PMID 20351675. PDF , Article$.
    Department of Neurology, Bellaria Hospital, Bologna, Italy2 Vascular Diseases Centre, University of Ferrara, Italy
14. [marrie10a] Marrie RA, Rudick R, Horwitz R, Cutter G, Tyry T, Campagnolo D, and Vollmer T: Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology. 2010 Mar;74(13):1041-7. PMID 20350978, doi:10.1212/WNL.0b013e3181d6b125, PDF , Article$. Interview.
    Health Sciences Center, GF-533, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada

Recent research has suggested that many people with MS have blockages in the veins that drain the brain (CCSVI) and that this problem is an important part of the MS disease process.

Dr. Bianca Weinstock-Guttman and Dr. Robert Zivadinov of the University of Buffalo are currently leading a major clinical trial to investigate CCSVI. They will present an overview of CCSVI and their preliminary results.

Friday, April 30th, Coast Plaza Hotel, Calgary, Canada

Update 01.07.2010:
Webcast and Q&A Session are available online.

There is soon the big neurology meeting: American Academy of Neurology (AAN) Annual Meeting 2010. Toronto, 10–17 Apr 2010. [aan10a]

Presentations covering CCSVI

Invited Speaker Session

• Zamboni P: Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis: A Paradigm Shift in the Physiology of Cerebral Venous Return. 14 Apr 2010, 5.30pm - 5.50pm. Program (PDF) p67. [pres_zamboni10b]

Platform Session:

• Poloni GU, Zamboni P, Haacke EM, Bastianello S, Dwyer MG, Bergsland N, Schirda C, Wack D, Magnano C, Weinstock-Guttman B, Salvi F, Hojnacki D, Zivadinov R: Quantitative Venous Vasculature Assessment on Susceptibility-Weighted Imaging Reflects Presence of Severe Chronic Venous Insufficiency in the Brain Parenchyma of Multiple Sclerosis Patients. A Case-Control Study. 14 Apr, Integrated Neuroscience: Multiple Sclerosis Imaging (2:00 PM-3:30 PM). [pres_poloni10a]

5 Poster Sessions:

• Magnano C, Schirda C, Weinstock-Guttman B, Hojnacki D, Bergsland N, Kennedy C, Reuther J, Brooks C, Dwyer MG, Zivadinov R: Cine Cerebrospinal Fluid Imaging in Multiple Sclerosis. A Case-Control Study.14 Apr, Poster Session III: Multiple Sclerosis and Related Diseases: MRI/Technique (7:30 AM-12:00 PM). [pos_magnano10a]
• Zamboni P, Menegatti E, Weinstock-Guttman B, Dwyer MG, Schirda C, Malagoni AM, Hojnacki D, Kennedy C, Carl E, Bergsland N, Magnano C, Bartolomei I, Salvi F, Zivadinov R : Hypoperfusion of Brain Parenchyma Is Strongly Associated with the Severity of Chronic Cerebrospinal Venous Insufficiency in Patients with Multiple Sclerosis. 14 Apr, Poster Session III: Multiple Sclerosis and Related Diseases: MRI/Technique (7:30 AM-12:00 PM). [pos_zamboni10a]
• Dwyer MG, Zamboni P, Haacke EM, Menegatti E, Weinstock-Guttman B, Schirda C, Malagoni AM, Hojnacki D, Kennedy C, Carl E, Bergsland N, Hussein S, Heininen-Brown M, Bartolomei I, Salvi F, Zivadinov R: Chronic Cerebrospinal Venous Insufficiency and Iron Deposition on Susceptibility-Weighted Imaging in Patients with Multiple Sclerosis. 14 Apr, Poster Session III: Multiple Sclerosis and Related Diseases: MRI/Technique (7:30 AM-12:00 PM). [pos_dwyer10a]
• Schirda C, Zamboni P, Magnano C, Lindzen E, Wack D, Weinstock-Guttman B, Ramasamy D, Carl E, Hojnacki D, Kennedy C, Dwyer MG, Bergsland N, Cox JL, Salvi F, Zivadinov R: Objective Quantification of Cerebrospinal Fluid (CSF) Flow Rate in Cerebral Aqueduct in Patients with Multiple Sclerosis. 14 Apr, Poster Session: Integrated Neuroscience: Multiple Sclerosis Imaging (3:30 PM-4:30 PM). [pos_schirda10a]
• Zivadinov R, Marr K, Ramanathan M, Zamboni P, Benedict RRHB, Cutter G, Kennedy C, Elfadil M, Hojnacki D, Munschauer F, Reuther J, Brooks C, Hunt K, Andrews M, Weinstock-Guttman B: Combined Transcranial and Extracranial Venous Doppler Evaluation (CTEVD Study). Description of the Design and Interim Results of an Epidemiological Study of the Prevalence of Chronic Cerebrospinal Venous Insufficiency in MS and Related Diseases. 15 Apr, Poster Session VI: Multiple Sclerosis and Related Diseases: Clinical Trials (3:00 PM-7:30 PM). [pos_zivadinov10a]

Webcasts:

• Zamboni P, Zivadinov R, Common A, Miller A: Live web forum about CCSVI and MS. Hosted by MS Society and the American Academy of Neurology. 14 Apr 12:00 pm (noon) ET (or 18h CEST, Zurich). Register now online. See full article.[webcast_aan10]

Note: Saturday, Apr 10 7 pm ET on CTV The Liberation War. The fight between patients and the medical community over the MS treatment first revealed by W5 last November. CTV W5 Trailer (19s). (Or on Youtube). See full article.