ISNVD Abstract Book

SATURDAY – FEBRUARY 18, 2012 1:10pm-1:30pm
Consensus on US CCSVI screening criteria (Sandra Morovic, ITALY-CROATIA)
CCSVI is a syndrome characterized by stenoses or obstructions of the internal jugular vein (IJV) and/or azygos
veins (AZV) with disturbed flow and formation of collaterals. Most common venous lesions are truncular
vascular malformations. Catheter venography is a gold standard for assessment of lesions producing CCSVI,
but it is invasive and cannot be used as a screening method. Ultrasound is an ideal, non-invasive, bedside, realtime
screening tool with high sensitivity and specificity. It is a valuable diagnostic test, in presence of which,
catheter venography will only be needed when a decision has already been made for intervention.
Recommendations with a protocol, methodology, and criteria on CCSVI screening using ultrasound, have been
proposed during a 2011 Consensus Conference, at the 1 st ISNVD Meeting. At least two criteria have to be
positive to consider CCSVI: 1) Bidirectional flow in one or both IJVs in both positions, or bidirectional flow in
one, with absence of flow in the other position and/or B) reversal or bidirectional flow in one or both vertebral
veins (VVs) in both positions. 2) Bidirectional flow in intracranial veins and sinuses (additional criteria). 3)
Reduction of IJV cross sectional area (CSA) in supine position to ≤0.3 cm 2 which does not increase with
Valsalva manoeuvre, and/or B) Intraluminal defects combined with hemodynamic changes. Valve leaflet/s
immobility confirmed by M-mode. 4) Absence of detectable flow in IJV and/or VV, in both positions, or B) In
one posture, absence of detectable flow in IJV and/or VV, and bidirectional flow detected in the other position,
same side. 5) CSA of IJV is greater in sitting than in lying position or B) Appears almost unchanged despite
change in posture. 6) Performance of CCSVI screening protocol, on both sides and in both positions, ensures
high scanning reproducibility with comparable accuracy between centers.
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