European Journal of Vascular & Endovascular Surgery

‘Doppler Ultrasound Examination of Multiple Sclerosis Patients and Control Participants: Inter-observer Agreement and Association with Disease’

We would like to comment on the recently published study ‘Doppler Ultrasound Examination of Multiple Sclerosis Patients and Control Participants: Inter-observer Agreement and Association with Disease’ by Laukontaus et al.1 In our opinion this study has some limitations, making the conclusion questionable. Namely, data are missing on training of investigators in diagnosis of chronic cerebrospinal venous insufficiency (CCSVI).
Diagnosis of extracranial venous system pathologies, especially in patients with multiple sclerosis (MS), is demanding, and without specific training this examination is very difficult. Likewise, the investigators used different ultrasound equipment with different linear probes that could influence final outcome, bearing in mind standard error in measurement with contributing human factor.
The authors agreed on CCSVI criterion 3 (CSA _ 0.3 cm2 ), which was seen in 45% of control participants compared with 65% of MS _ 2 patients (p . .09) and 70% of the MS > 10 patients (p . .022), and mean CSA measurement, which was 0.52 _ 0.34 cm2 in control participants against0.37 _ 0.32 cm2 MS _ 2 group (p . .007) and 0.36 _ 0.29 cm2 MS > 10 group (p . .001). These findings indicate that extracranial venous stenosis could be more common in patients suffering from MS than in healthy control participants, regardless of disagreement in other parameters, making presented ultrasound findings appropriate.
Besides ultrasound, multidetector CT (MDCT) or catheter venography and gradient pressure measurement2 should be done before final diagnosis of CCSVI can be made.

REFERENCES
1 Laukontaus SJ, Kagayama T, Lepäntalo M, Atula S, Färkkilä M, Albäck A, et al. Doppler ultrasound examination of multiple sclerosis patients and control participants: inter-observer agreement and association with disease. Eur J Vasc Endovasc Surg 2013;46:466e72.
2 Radak D, Tanaskovic S, Antonic Z, Kolar J, Aleksic N, Ilijevski N. Compressive syndrome of internal jugular veins in multiple sclerosis: does it matter? Phlebology 2012 Sep 17 [Epub ahead of print].

D. Radak Vascular Surgery Clinic, “Dedinje” Cardiovascular Institute, Belgrade, Serbia School of Medicine, Belgrade University, Belgrade, Serbia
S. Tanaskovic*Vascular Surgery Clinic, “Dedinje” Cardiovascular Institute, Belgrade, Serbia
N. Ilijevski Vascular Surgery Clinic, “Dedinje” Cardiovascular Institute, Belgrade, Serbia
School of Medicine, Belgrade University, Belgrade, Serbia
*Corresponding author. Email-address: drslobex@yahoo.com (S. Tanaskovic) Available online xxx _ 2013 European Society for Vascular Surgery. Published by Elsevier Ltd.
All rights reserved. http://dx.doi.org/10.1016/j.ejvs.2013.09.010
DOI of original article: http://dx.doi.org/10.10