Comparison of Intravascular Ultrasound With Conventional Venography for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal Venous Insufficiency

J Vasc Interv Radiol. 2013 Oct;24(10):1487-98.e1. doi: 10.1016/j.jvir.2013.06.012. Epub 2013 Aug 14.


Purpose: To investigate prevalence of extracranial abnormalities in azygos and internal jugular (IJ) veins using conventional venography and intravascular ultrasound (IVUS) in patients with multiple sclerosis (MS) being evaluated for chronic cerebrospinal venous insufficiency, a condition of vascular hemodynamic dysfunction.

Materials and methods: PREMiSe (Prospective Randomized Endovascular therapy in Multiple Sclerosis) is a venous angioplasty study that enrolled 30 patients with relapsing MS. The patients fulfilled two or more venous hemodynamic extracranial Doppler sonography screening criteria. Phase I of the study included 10 patients and was planned to assess safety and standardize venography, IVUS, and angioplasty and blinding procedures; phase II enrolled 20 patients and further validated diagnostic assessments using the two invasive techniques. Venography was considered abnormal when ≥ 50% lumen-diameter restriction was detected. IVUS was considered abnormal when ≥ 50% lumen-diameter restriction, intraluminal defects, or reduced pulsatility was detected.

Results: No venography-related or IVUS-related complications, including vessel rupture, thrombosis, or side effects of contrast media were recorded among the 30 study patients. IVUS-detected venous abnormalities, including chronic, organized, thrombus-like inclusions were observed in 85% of azygos, 50% of right IJ, and 83.3% of left IJ veins, whereas venography demonstrated stenosis of ≥ 50% in 50% of azygos, 55% of right IJ, and 72% of left IJ veins. Sensitivity of venography for detecting IVUS abnormalities was 52.9%, 73.3%, and 80% for the azygos, left IJ, and right IJ veins, respectively.

Conclusions: IVUS assessment of azygos and IJ veins showed a higher rate of venous abnormalities than venography. IVUS provides a diagnostic advantage over conventional venography in detecting extracranial venous abnormalities indicative of chronic cerebrospinal venous insufficiency.

Keywords: CCSVI; DS; Doppler sonography; ET; IJ; IVUS; MS; PREMiSe; Prospective Randomized Endovascular therapy in Multiple Sclerosis; chronic cerebrospinal venous insufficiency; emptying time; internal jugular; intravascular ultrasound; multiple sclerosis.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Azygos Vein / abnormalities*
  • Azygos Vein / diagnostic imaging
  • Echoencephalography / methods*
  • Female
  • Humans
  • Jugular Veins / abnormalities*
  • Jugular Veins / diagnostic imaging
  • Male
  • Middle Aged
  • Phlebography / methods*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ultrasonography, Interventional / methods*
  • Venous Insufficiency / diagnosis*