Quantitative Flow Measurements in the Internal Jugular Veins of Multiple Sclerosis Patients Using Magnetic Resonance Imaging

Abstract

Blood flow through the IJVs was reduced in the MS population with stenoses compared to those without.

Lack of correlation between extracranial venous abnormalities and multiple sclerosis: a quantitative MRI study

“…2 Among the potential factors that were related to MS, abnormal venous haemodynamics in the neck, including venous reflux and stenosis, has been hypothesized to be a feature of MS. [3][4][5][6] During the past few years, different studies were carried out to investigate the possible role of extracranial venous flow abnormalities in MS. These studies used different image modalities such as ultrasound 3,5,[7][8][9][10][11][12][13][14] and MRI, including contrast-enhanced MR venography (CE-MRV), phasecontrast MRI or time-of-flight sequences, 4,[15][16][17][18][19][20] and a combination of different imaging modalities. [21][22][23][24][25][26] These studies, however, yielded somewhat conflicting results, and the role of venous abnormalities in MS still remains in discussion.…”

Chronic cerebrospinal venous insufficiency: current perspectives

“…A functional MRV study revealed significant IJV flow impairment in 46% of 200 patients with 44 This abnormal flow was not seen in healthy controls studied by the same authors. 43 Importantly, flow restriction demonstrated by MRV studies [42][43][44] was less frequent than the prevalence of jugular abnormalities found in catheter venography studies (70%-90%). 1,[20][21][22][23][24][25][26][27]32,33 This favors the idea that jugular valves, even if stenotic, can affect flow differently.…”

“…41 and magnetic resonance techniques evaluating both morphology and flow. 30,[42][43][44] Further, current magnetic resonance imaging is not very good at demonstrating pathology of the jugular valves (catheter venography studies tell us that this is the most common CCSVI abnormality). 25,[27][28][29]45 These valves are tiny structures, which are not easily visible on standard magnetic resonance images.…”

“…44 In addition, localization of stenoses in the lower part of the IJV led to more severe reduction of flow. 42,43 Interestingly, total arterial flow was not different between multiple sclerosis patients with and without stenoses, 42,44 so cerebral venous outflow in "stenotic" patients with multiple sclerosis was probably shifted from the IJVs to an alternative venous network. However, it is noteworthy that one study using functional magnetic resonance flow assessment did not reveal a significant difference in flow between patients with multiple sclerosis and healthy controls (the controls did not have statistically significant higher flow volume).…”

“…52 Still, in this study, patients with severe narrowing of the IJV were not assessed separately, as they were in other similar studies. [42][43][44] The fact that the IJVs were evaluated only in the supine position (most magnetic resonance units cannot examine standing or sitting patients) appears to be the main limitation of current MRV studies. Doppler sonography, on the contrary, can assess these veins both in the supine and upright body positions.…”