Department of Neuroscience, University of Padua, Via Giustiniani, 5, 35128 Padua, Italy.
J Neurol. 2012 Dec;259(12):2585-9. doi: 10.1007/s00415-012-6541-3. Epub 2012 May 31.
To systematically review the ultrasonographic criteria proposed for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI). The authors analyzed the five ultrasonographic criteria, four extracranial and one intracranial, suggested for the diagnosis of CCSVI in multiple sclerosis (MS), together with the references from which these criteria were derived and the main studies that explored the physiology of cerebrospinal drainage. The proposed CCSVI criteria are questionable due to both methodological and technical errors: criteria 1 and 3 are based on a scientifically incorrect application of data obtained in a different setting; criteria 2 and 4 have never been validated before; criterion 2 is technically incorrect; criteria 3 and 5 are susceptible to so many external factors that it is difficult to state whether the data collected are pathological or a variation from the normal. It is also unclear how it was decided that two or more of these five ultrasound criteria may be used to diagnose CCSVI, since no validation of these criteria was performed by different and independent observers nor were they blindly compared with a validated gold-standard investigation. The European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) has considerable concerns regarding the accuracy of the proposed criteria for CCSVI in MS. Therefore, any potentially harmful interventional treatment such as transluminal angioplasty and/or stenting should be strongly discouraged.
系统回顾慢性脑脊髓静脉功能不全（CCSVI）的超声诊断标准。作者分析了多发性硬化症（MS）CCSVI 诊断中提出的五个超声标准，包括四个颅外标准和一个颅内标准，以及这些标准的来源参考文献和探索脑脊液引流生理学的主要研究。所提出的 CCSVI 标准存在问题，原因在于方法和技术错误：标准 1 和 3 基于对在不同环境中获得的数据的科学上不正确的应用；标准 2 和 4 从未经过验证；标准 2 在技术上是不正确的；标准 3 和 5 容易受到如此多的外部因素的影响，以至于很难确定所收集的数据是病理性的还是正常变异。也不清楚如何决定可以使用这五个超声标准中的两个或更多标准来诊断 CCSVI，因为没有由不同的和独立的观察者对这些标准进行验证，也没有将它们与经过验证的金标准调查进行盲目比较。欧洲神经超声学和脑血液动力学学会（ESNCH）对 MS 中 CCSVI 提出的标准的准确性存在相当大的担忧。因此，应强烈劝阻任何潜在的有害介入治疗，如经腔血管成形术和/或支架置入术。
