ISNVD Abstract Book

Purpose
Kenneth Mandato, MD; Jedidiah G Almond, MD; Meridith Englander, MD
Shirish Parikh, MD; Gary P Siskin, MD
Radiology at Albany Medical College Albany, NY
To evaluate the ability of ultrasound (US) to diagnose chronic
cerebrospinal venous insufficiency (CCSVI) in patients with
multiple sclerosis.
Materials and Methods
A retrospective study of all MS patients treated for CCSVI
during an 8-month period was performed. The study
population consisted of all patients undergoing US of the
internal jugular veins (IJV) within 24 hours of venography.
Patients who received a diagnostic ultrasound at another
institution before undergoing treatment were not included
in this analysis. US was performed utilizing the protocol
described by Zamboni, et al. A positive US met 2/5 criteria
for CCSVI. The US results were also evaluated based on the
findings on each side (right or left). A positive unilateral US
met 2/4 criteria (without the transcranial evaluation of the
deep cerebral veins). A positive venogram was defined as
one identifying a ≥50% stenosis in at least one vein,
including the azygos vein. The US and venography findings
were then compared to determine if US is an effective tool
for diagnosing CCSVI.
Figure 1A: Realtime doppler sonography reveals normal
venography
Results
416 patients were treated during the study period; the study
population consisted of 310 patients (mean age 49 years;
30% male and 70% female). 224/310 patients (72%) had a
positive US, and 155 (69%) of these patients had a positive
CV; 86/310 patients (28%) had a negative US, and 66 (77%)
of these patients had a positive venogram (p=0.240) [Figures
1A, 1B]. An ROC curve was generated to further evaluate
ultrasound as a diagnostic test and the AUC=0.463. 300/310
(97%) patients underwent PTA of at least one vessel (215/224
with a positive US and 85/86 with a negative US) because
venography showed either a ≥50% stenosis or a flow
abnormality in association with a