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International Angiology 2011 December;30(6):571-97

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound - Recommendations for a protocol

Zamboni P. ¹, Morovic S. ^{1, 2}, Menegatti E. ¹, Viselner G. ³, Nicolaides A. N. ⁴ ✉

¹ Vascular Diseases Center, University of Ferrara, Ferrara, Italy; ² Department of Neurology, Sestre Milosrdnice University Hospital Center, Zagreb, Republic of Croatia; ³ Neurological Institute Mondino, University of Pavia, Pavia, Italy; ⁴ Vascular Screening and Diagnostic Centre, Cyprus

Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses or obstructions of the internal jugular and/or azygos veins with disturbed flow and formation of collateral venous channels. Studies using ultrasound in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 70%; range 0-100%; N.=1496), whereas, in normal controls and patients without MS the prevalence was much lower (mean 10%; range 0-36%; N.=635). Ultrasound uses a combination of physiological measurements as well as anatomical imaging and has been used for the detection of CCSVI by different centers with variable results. A high prevalence ranging from 62% to 100% of obstructive lesions has been found by some teams in patients with MS compared with a lower prevalence of 0-25% in controls. However, absence of such lesions or a lower prevalence (16-52%) has been reported by others. This variability could be the result of differences in technique, training, experience or criteria used. The current lack of a methodology shared among experts is a confounding element in epidemiologic studies, and does not permit further Bayesan or other kind of analysis. In order to ensure a high reproducibility of Duplex scanning with comparable accuracy between centers, a detailed protocol with standard methodology and criteria is proposed. This is also necessary for training. It has been shown that inter-rater variability increases post-training (from k=0.47 to k=0.80), while within-rater reproducibility in trained operators was k=0.75. Finally, the consensus document proposes a reporting standard of Duplex measurements, and future research to answer areas of uncertainty.