Using Magnetic Resonance Imaging as a Means to Study Chronic Cerebral Spinal Venous Insufficiency in Multiple Sclerosis Patients

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The goal of this work is to present a broad magnetic resonance imaging (MRI) protocol for use in the study of chronic cerebrospinal venous insufficiency (CCSVI). The CCSVI MRI protocol includes the following sequences: time-resolved contrast-enhanced 3D MR angiography, 2D time-of-flight MR venography, and 3D volumetric interpolated breath-hold examination to assess venous structural abnormalities; phase-contrast MR imaging at different levels in the neck and thoracic cavity to quantify flow through the veins, arteries, and cerebrospinal fluid; T2-weighted imaging, T2-weighted fluid-attenuated inversion recovery, and pre- and post-contrast T1-weighted imaging of the brain for examinations of parenchymal lesions; and finally, susceptibility-weighted imaging for quantification of iron deposition in the brain. Data from 111 clinically definite multiple sclerosis patients were assessed for potential structural and flow CCSVI risk criteria, including stenosis, atresia, aplasia, dominant to subdominant venous flow ratio (D:sD), and the sum of their flow rates. Of the 111 patients, 50 (45%) were determined to be nonstenotic (NST) with no stenosis or atresia in their internal jugular veins (IJV), and the rest 61 (55%) were stenotic (ST) having at least one internal jugular vein stenosis or atresia. No occurrence of aplasia was observed. A D:sD of greater than 3:1 was observed in 15 (24.6%) patients of the ST group and 2 (4.0%) patients of the NST group. A sum of dominant and subdominant venous flow rate of <8 mL/s was observed in 22 (36.1%) patients of the ST group and 6 (12.0%) patients of the NST group. MRI provides valuable information in the observation of potential CCSVI risk factors. Low total flow in the 2 dominant veins seemed to be the strongest indicator for risk of having stenoses in the multiple sclerosis population.

Section snippets

Materials and Methods

The imaging protocols and parameters provided here are based on our experience with a 3-T Siemens scanner. For different scanners from the same or different manufacturers, sequences similar to those described herein are available which will generate comparable results. For research purposes, relevant clinical data, which should be collected, include but are not necessarily limited to the following: age, weight, height, expanded disability status scale (EDSS),18 the MS impact scale (MSIS-29),

Results

The inter- and intraprocessor variability for our processing group has been reported previously.32 Specifically, a 3-way analysis of variance showed no statistical significance in segmentation of PC-MRI vessel contours (P = 0.53 for interprocessor variability and P = 0.18 for intraprocessor variability) and CSA stenosis measurements on 2D TOF MRV (P = 0.62 and P = 0.39, respectively).

Based on the anatomical assessment using CE MRA/V and TOF MRV, the patients were divided into stenotic (ST) or

Discussion

The CCSVI MRI protocol presented here contains a comprehensive series of imaging sequences to probe both anatomical and vascular structure as well as function (flow). Recent studies32 and clinical treatment18 suggest that there is a strong vascular component to CCSVI associated with MS. Indirect evidence of a venous link to increased iron content also exists,41 and a recent work using SWI to quantify iron also showed some correlation with iron content and disease progression.8 Considering the

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    EMH is the president of Magnetic Resonance Innovations, Inc. DU and SE are employees of Magnetic Resonance Innovations, Inc.

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