Comparison of MR and Contrast Venography of the Cervical Venous System in Multiple Sclerosis - facebook prikbord

From the Departments of Radiology (G.Z., J.R., R.J.H.) and Cardiothoracic Surgery (M.D.D.), Stanford University, Stanford, California; Department of Radiology (G.Z., N.J.F., R.J.H.), Stanford University Medical Center, Stanford, California.

Please address correspondence to Greg Zaharchuk, PhD, MD, 1201 Welch Rd, PS-04, Stanford University Medical Center, Mailcode 5488, Stanford, CA 94305-5488; e-mail: gregz@stanford.edu

BACKGROUND AND PURPOSE: MRV has been proposed as a possible screening method to identify chronic cerebrospinal venous insufficiency, which may play a role in MS. We report our initial experience comparing MRV and CV in MS patients to evaluate venous stenosis and collateral venous drainage.

MATERIALS AND METHODS: Time-of-flight and time-resolved imaging of contrast kinetics MRV and CV were performed in 39 MS patients. The presence and severity of both IJ vein caliber changes and non-IJ collaterals were graded by using a 4-point scale by 2 radiologists in an independent and blinded manner.

RESULTS: Both studies frequently showed venous abnormalities, most commonly IJ flattening at the C1 level and in the lower neck. There was moderate-to-good agreement between the modalities ( ${kappa}$ = 0.55; 95% CI, 0.45%–0.65%). For collaterals, agreement was only fair ( ${kappa}$ = 0.30; 95% CI, 0.09%–0.50%). The prevalence of IJ segments graded mild or worse on CV was 54%. If CV was considered a standard, the sensitivity and specificity of MRV was 0.79 (0.71–0.86) and 0.76 (0.67–0.83), respectively. Degree of stenosis was related to the severity of collaterals for CV but not for MRV.

CONCLUSIONS: IJ caliber changes were seen in characteristic locations on both MRV and CV in MS patients. Agreement between modalities was higher for stenosis than for collaterals. If CV is considered a standard, MRV performance is good but may require additional improvement before MRV can be used for screening.

Abbreviations: CCSVI, chronic cerebrospinal venous insufficiency • CI, confidence interval • CV, contrast venography • EDSS, Expanded Disability Status Scale • IJ, internal jugular • MIP, maximum intensity projection • MRV, MR venography • MS, multiple sclerosis • nc, not calculable • NPV, negative predictive value • PPV, positive predictive value • TOF, time-of-flight • TRICKS, time-resolved imaging of contrast kinetics

http://www.ajnr.org/cgi/content/abstract/ajnr.A2549v1?maxtoshow&hits=1&RESULTFORMAT&andorexacttitle=and&andorexacttitleabs=and&fulltext=ccsvi&andorexactfulltext=and&searchid=1&usestrictdates=yes&resourcetype=HWCIT&ct