PT  - JOURNAL ARTICLE
AU  - Fiona Costello
AU  - Jayesh Modi
AU  - David Lautner
AU  - Deepak Bhayana
AU  - James N. Scott
AU  - W. Jeptha Davenport
AU  - Jessie Trufyn
AU  - Richard Frayne
AU  - Viesha A. Ciura
AU  - Mayank Goyal
AU  - Jean Mah
AU  - Michael D. Hill
TI  - Validity of the diagnostic criteria for chronic cerebrospinal venous insufficiency and association with multiple sclerosis
AID  - 10.1503/cmaj.131431
DP  - 2014 Aug 05
TA  - Canadian Medical Association Journal
PG  - E418--E426
VI  - 186
IP  - 11
4099  - http://www.cmaj.ca/content/186/11/E418.short
4100  - http://www.cmaj.ca/content/186/11/E418.full
SO  - CMAJ2014 Aug 05; 186
AB  - Background: The chronic cerebrospinal venous insufficiency theory proposes that altered cerebral venous hemodynamics play a role in the pathophysiology of multiple sclerosis. We aimed to explore the validity of this hypothesis by assessing the diagnostic criteria for chronic cerebrospinal venous insufficiency in persons with and without multiple sclerosis.Methods: We compared the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls using extracranial Doppler ultrasonography and gadolinium-enhanced magnetic resonance venography. Interpreting radiologists were blinded to the clinical status of participants.Results: We enrolled 120 patients with multiple sclerosis and 60 healthy controls. High proportions of both patients (67/115 [58%]) and controls (38/60 [63%]) met 1 or more of the proposed ultrasound criteria for diagnosis of chronic cerebrospinal venous insufficiency (p = 0.6). A minority of patients (23/115 [20%]) and controls (6/60 [10%]) fulfilled 2 or more of the proposed criteria (p = 0.1). There were no differences between patients and controls in the prevalence of each individual ultrasound criterion. Similarly, there were no differences in intracranial or extracranial venous patency between groups, as measured by magnetic resonance venography.Interpretation: We detected no differences in the proportion of venous outflow abnormalities between patients with multiple sclerosis and healthy controls. Moreover, our study revealed significant methodologic concerns regarding the proposed diagnostic criteria for chronic cerebrospinal venous insufficiency that challenge their validity.