Diagnostic accuracy of current sonographic criteria for the detection of outflow abnormalities in the internal jugular veins

Abstract

Our research has shown that currently used extracranial sonographic criteria for the detection of obstructive venous abnormalities in the IJVs are of limited diagnostic value. For the time being, diagnosis of this vascular pathology should be given using catheter venography.

Chronic cerebrospinal venous insufficiency: current perspectives

“…The prevalence of these lesions was over 50% 32,33 and was even higher (about 90%) when more liberal definition of an abnormality or IVUS were used. 1,[20][21][22][23][24][25][26][27]104 Similarly, the results of MRV studies were quite consistent, ie, IJV stenoses were found in 25%-70% of patients with multiple sclerosis, 30,32,36,37,39,40,44,46,49 which is comparable with the results of catheter venography. A lower frequency of IJV abnormalities revealed by MRV probably resulted from the fact that this imaging modality cannot precisely assess the jugular valve, which is the most common site of CCSVI pathology.…”

“…19 Most of the studies that utilized catheter veno graphy have revealed pathologic venous flow in 95%-100% of patients with multiple sclerosis (Figure 1). 1,[20][21][22][23][24][25][26][27] Importantly, intravascular ultrasound (IVUS) was found to be very helpful as an adjunct to catheter venography. A combination of venography and IVUS provides a comprehensive assessment of venous anatomy, endoluminal structures, and flow.…”

“…Different patient ages and the clinical characteristics of multiple sclerosis may partially explain the lack of congruent results in the studies. In addition, the majority of authors did not verify the results of Doppler sonography against a more reliable diagnostic test, such as catheter angiography 26 or IVUS. 30,31 The researchers assessed the IJVs at different levels, used different definitions of normal and abnormal veins, used different sonographic machines, and the sonographers had very different experience in studying the IJVs (it is obvious that some of them evaluated these veins in a manner similar to that used for examination of the carotid arteries).…”

“…Obviously, current sonographic CCSVI criteria, 1,2,58 even those that have been recently modified, 105 are not good enough to evaluate patients correctly. 26,76 However, some sonographers, even in blinded studies, have been able to reveal a frequency of CCSVI that was probably roughly correct, 37,79,80 while others have reported an unreliably low prevalence of CCSVI. Looking more closely at the methodologies of these studies, one should conclude that even if the authors performed the studies properly, their interpretation of the sonographic findings was different.…”

“…However, this parameter is actually not different between healthy and abnormal IJVs. 26 It has recently been suggested that the flow volume in the IJV should be assessed perhaps instead of the ∆CSA, and assumed to be pathological if it is higher in the upright position than in the supine position. 106 There is also much controversy surrounding sonographic study of the cerebral veins.…”