Wang Zhongao, Ding Jiayue, Bai Chaobo, Ding Yuchuan, Ji Xunming, Meng Ran
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
Front Neurol. 2020 Sep 23;11:913. doi: 10.3389/fneur.2020.00913. eCollection 2020.
As an indispensable part of the cerebral venous system, the extracranial cerebrospinal venous system is not fully recognized. This study aimed to analyze the clinical classification and imaging characteristics of chronic cerebrospinal venous insufficiency (CCSVI) quantitatively. A total of 128 patients, who were diagnosed as CCSVI by jugular ultrasound and contrast-enhanced magnetic resonance venography (CE-MRV), were enrolled from May 2018 through May 2019. For the patients with possible extraluminal compression, computed tomography venography (CTV) was applied to estimate the degree of internal jugular venous stenosis (IJVS) and rank the vertebral venous collateral circulation. The causes of extraluminal compression induced IJVS included osseous compression (78.95%), carotid artery (24.21%), sternocleidomastoid muscle (5.79%), swollen lymph node (1.05%), and unknown reasons (5.26%). The subtypes of non-compression CCSVI included the high jugular bulb (77.27%), fenestration of the internal jugular vein (IJV) (7.27%), internal jugular phlebectasia (2.73%), tortuous IJV (0.91%), IJV thrombosis (14.55%), and elongated venous valves with/without erythrocyte aggregation (13.64%). For extraluminal compression induced IJVS, the ratio of severe vertebral venous expansion was higher in the severe IJVS group than that in the mild IJVS group ( < 0.001). The IJVS degree was higher in the severe vertebral venous expansion group than in the mild vertebral venous expansion group ( < 0.001). A multimodal diagnostic system is necessary to improve the diagnostic accuracy of CCSVI. The vertebral venous system is an important collateral circulation for CCSVI, which may be a promising indicator for evaluating IJVS degree.
作为脑静脉系统不可或缺的一部分，颅外脑脊髓静脉系统尚未得到充分认识。本研究旨在定量分析慢性脑脊髓静脉功能不全（CCSVI）的临床分类及影像学特征。2018年5月至2019年5月，共纳入128例经颈静脉超声及对比增强磁共振静脉成像（CE-MRV）诊断为CCSVI的患者。对于可能存在管腔外压迫的患者，采用计算机断层扫描静脉成像（CTV）评估颈内静脉狭窄程度（IJVS）并对椎静脉侧支循环进行分级。管腔外压迫导致IJVS的原因包括骨质压迫（78.95%）、颈动脉（24.21%）、胸锁乳突肌（5.79%）、肿大淋巴结（1.05%）及不明原因（5.26%）。非压迫性CCSVI的亚型包括颈静脉球高位（77.27%）、颈内静脉（IJV）开窗（7.27%）、颈内静脉扩张（2.73%）、IJV迂曲（0.91%）、IJV血栓形成（14.55%）以及伴有/不伴有红细胞聚集的静脉瓣膜延长（13.64%）。对于管腔外压迫导致的IJVS，重度IJVS组重度椎静脉扩张的比例高于轻度IJVS组（<0.001）。重度椎静脉扩张组的IJVS程度高于轻度椎静脉扩张组（<0.001）。需要一种多模式诊断系统来提高CCSVI的诊断准确性。椎静脉系统是CCSVI的重要侧支循环，可能是评估IJVS程度的一个有前景的指标。
