Abstract
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 (κ = 0.55; 95% CI, 0.45%–0.65%). For collaterals, agreement was only fair (κ = 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.
Footnotes
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- 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
- © 2011 American Society of Neuroradiology