Chronic cerebrospinal venous insufficiency: does ultrasound really distinguish multiple sclerosis subjects from healthy controls?

Objectives: To investigate the differences between multiple sclerosis (MS) and control subjects by using extracranial venous grey-scale, colour and spectral Doppler ultrasound.

Methods: The study included 62 subjects with a definitive diagnosis of MS and 54 control subjects. The cross sectional area (CSA), reflux during Valsalva manoeuvre, presence or absence of flow in the internal jugular vein (IJV) were assessed in upright and supine positions. The IJV and vertebral vein (VV) flow volumes (BFV) were also studied.

Results: Reflux in the IJV, an upright CSA greater than a supine CSA, and the presence or absence of flow in the IJV were not different between MS and control subjects. A CSA ≤ 0.3 cm(2) was observed to be significantly higher in MS subjects. The IJV BFV was not significantly different between the groups; however, the VV BFV was significantly higher on the right side and lower on the left side in MS subjects.

Conclusions: Our use of ultrasound criteria reported in the literature for MS reveals differences between healthy controls and MS subjects that also overlap. Our experience suggests that Doppler ultrasound may not be clinically reliable and more studies are needed to clarify its role, if any. Key Points • Chronic cerebrospinal venous insufficiency is a controversial topic in multiple sclerosis. • Ultrasound assessment of extracranial veins has yielded different results in the literature. • These differences may be due to dependence on Doppler and selection bias. • We found variations in vertebral vein flow in patients with multiple sclerosis.