Evaluation of internal jugular and vertebral vein pathologies in multiple sclerosis cases using color doppler and B-mode sonography.
HealthMed . 2013, Vol. 7 Issue 12, p3111-3118. 8p
Bora, Aydin; Yavuz, Alpaslan; Kaya, Cihat; Berkoz, Mehmet

Background and Aim: Multiple Sclerosis (MS) is a chronic demyelinating and degenerative disease that affects the central nervous system. Chronic Cerebrospinal Venous Insufficiency (CCSVI) is a recently described condition that may possibly contribute to the symptoms often experienced by patients with MS. We aim to compare the hemodynamics and the morphology of the internal jugular veins and vertebral veins using Color-Doppler and B-mode sonongraphy in MS cases and in healthy individuals as a control group. Also, flow volume of internal jugular vein (IJV) and vertebral vein (VV) in both supine and sitting position in MS and control groups. Materials and Methods: IJV and VV of 60 MS patients and healthy individuals were examined using Color-Doppler and B-mode ultrasound in sitting and supine positions. Changes in hemodynamics and the presence or absence of morphological changes were recorded and evaluated according to Zamboni criteria. The presence of at least two of the Zamboni criteria in the same individual was considerede positive for evidence of CCSVI. Presence of the extracranial Zamboni criteria and measurements of flow volume were examined on supine and sitting positions for both group. Results: In this study all the patients and control subjects were evaluated according to the first 4 criteria but the last criteria (reflux in the deep cerebral veins) was not assessed due to the lack of the required ultrasound probe in our institution. A subject was considered CCSVI positive if at least 2 Zamboni criteria were fulfilled. According to the described criteria, 76% of the MS patients showed abnormal findings and 21% of them showed evidence of CCSVI, however; only 33 individuals in control group showed abnormal findings and 1.6% of them showed evidence of CCSVI. The difference between groups is statistically significant (p<0.01). In addition we did not detect any statistically significant difference between both group's IJV-VV mean flow volumes which were examined in both sitting and supine positions (p>0.01). Conclusion: There is a strong association between CCSVI and MS. This relationship can be easily demonstrated with B-Mode and Color- Doppler Sonography: a simple and non-invasive method. However further large studies and meta-analyses are required for the accurate determination of this association.
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