Zaniewski M, Kostecki J, Kuczmik W, Ziaja D, Opala G, Świat M, Korzeniowski T, Majewski E, Urbanek T, Pawlicki K
Department of Surgery, Medical University of Silesia, District Specialist Hospital, Tychy, Poland.
Phlebology. 2013 Feb;28(1):24-31. doi: 10.1258/phleb.2011.011070. Epub 2012 Feb 22.
Recent clinical studies have suggested a relationship between multiple sclerosis (MS) and the occurrence of pathological changes in the jugular, vertebral and azygous veins that result in abnormal blood outflow from the brain and the spinal cord. Together, these pathological changes have been designated chronic cerebrospinal venous insufficiency (CCSVI). The aim of the present study was to evaluate the usefulness of duplex Doppler ultrasound in the evaluation of central nervous system venous outflow disturbances in patients suffering from MS.
We examined 181 patients with MS, diagnosed on the basis of the McDonald criteria, and 50 healthy volunteer controls. All patients underwent Doppler ultrasound examination of the internal jugular veins (IJV) and vertebral veins (VVs). The presence of outflow disturbances and morphological abnormalities were evaluated.
Pathological changes in the extracranial jugular veins were diagnosed in 148/181 MS patients (82%) and 7/50 control group volunteers (14%). The following abnormalities in the MS group were revealed: the presence of a reflux in the IJVs and/or VVs (54%), narrowing (54%), a complete block in the flow through the IJV (10%) and an abnormal postural control of the cerebral outflow route (25%). These particular pathologies were of statistical significance in the MS group compared with the control group. This study also revealed a correlation between the occurrence of inverted flow in patients in a sitting position and chronic progressive MS (P = 0.0033).
The examinations undertaken indicate a possible connection between MS and CCSVI. The widely accessible and highly sensitive and specific Doppler ultrasound test may be useful for revealing, and preliminary analysis of, CCSVI pathologies.
近期临床研究表明，多发性硬化症（MS）与颈静脉、椎静脉和奇静脉的病理变化之间存在关联，这些变化会导致大脑和脊髓的血液流出异常。这些病理变化共同被称为慢性脑脊髓静脉功能不全（CCSVI）。本研究的目的是评估双功多普勒超声在评估MS患者中枢神经系统静脉流出障碍中的作用。
我们检查了181例根据麦克唐纳标准确诊的MS患者和50名健康志愿者对照。所有患者均接受了颈内静脉（IJV）和椎静脉（VV）的多普勒超声检查。评估了流出障碍和形态学异常的存在情况。
181例MS患者中有148例（82%）被诊断为颅外颈静脉病理变化，50名对照组志愿者中有7例（14%）。MS组出现了以下异常：IJV和/或VV存在反流（54%）、狭窄（54%）、IJV血流完全阻塞（10%）以及脑流出途径的姿势控制异常（25%）。与对照组相比，这些特定病理在MS组中具有统计学意义。本研究还揭示了坐位患者出现逆流与慢性进展性MS之间的相关性（P = 0.0033）。
所进行的检查表明MS与CCSVI之间可能存在联系。广泛可用且高度敏感和特异的多普勒超声检查可能有助于揭示CCSVI病理并进行初步分析。
