Article Figures & Data
Figures
- Fig 1.
Qualitative grading of venous stenosis between 0 (none) and 3 (severe). Examples at the high IJ vein level demonstrate either no stenosis (A) or bilateral mild (B), moderate (C), and severe (D) stenosis. In some severe cases, the IJ was not visualized, as on the right in this example. The cases shown are bilateral for the purposes of example, but in general, left-right asymmetry in the degree of stenosis was more common.
- Fig 2.
Grading scale for collateral venous flow. Images shown are sagittal MIPs of either the left or right side of the neck from TRICKS MRV from the phase with the most venous opacification. Collateral scorings shown are: (A) none, 0, (B) mild, 1, (C) moderate, 2, and (D) severe, 3. In severe cases, prominent collaterals were sometimes seen over the posterior neck regions, as in this example.
- Fig 3.
A 35-year-old woman with relapsing-remitting MS diagnosed 5 years before imaging showing characteristic locations of venous abnormalities on 2D-TOF MRV. In the upper neck (A–C), flattening was often seen near C1 (arrows, B). In the mid- and lower neck (D–F), flattening can be seen between the sternocleidomastoid and anterior scalene muscles on the right (arrows, E).
- Fig 4.
A 38-year-old woman with relapsing-remitting MS for 3 years. A, High IJ stenosis adjacent to the right C1 lateral mass (arrow). B, CV shows the focal stenosis, whereas a delayed image (C) shows associated non-IJ collateral venous vessels. The left IJ seems normal on CV. The right high IJ was graded severe on both MRV and CV; the left IJ was graded by MRV as mild stenosis, due to the slightly flattened appearance, whereas it was called normal on CV (not shown).
- Fig 5.
A 36-year-old man with relapsing-remitting MS for 2 years, showing severe stenosis of the left mid-IJ on MRV (A) and early (B) and late (C) phases of CV (arrows). Enlarged posterior paraspinal venous collaterals are also noted on the venogram. In certain individuals, the course of the carotid artery swings across the IJ vein at this level, possibly causing compression.
- Fig 6.
A 41-year-old woman with relapsing-remitting MS for 6 years. A, MRV demonstrates moderate right (arrow) and severe left (arrow) lower IJ stenosis. CV demonstrates no appreciable stenosis in the low IJ segment on either side. Unsubtracted (B) and subtracted (C) CV after right IJ injection; unsubtracted (D) and subtracted (E) CV after left IJ injection. The cause of this lack of agreement between modalities remains unclear, though the degree of stenosis was less severe on the TRICKS images (F).
- Fig 7.
A 47-year-old man with 2 years of relapsing-remitting MS. A, Lateral view of MIP image of the left neck from TRICKS MRV. B, Multiple frames from CV with injection of the high left IJ. Both modalities rated the posterior paraspinal collaterals in this patient as moderate. An arrow points to a location of stenosis noted in the mid-IJ.
- Fig 8.
Relationship between collateral rating versus composite IJ vein stenosis score. There was a significant relationship between more non-IJ collaterals and increasing stenosis for the CV examination (ρ = 0.49) but not for the MRV examination (ρ = 0.18), based on rank correlation. Line is a locally weighted regression smoother. Points have been jittered for clarity.
Tables
Scan Type and Location Side and IJ Stenosis Scorea Left Right 0 1 2 3 0 1 2 3 CV High 10 8 9 12 8 11 15 5 Mid 26 1 8 4 34 3 2 0 Low 11 12 8 8 19 10 8 2 MRV High 9 5 14 11 8 7 14 10 Mid 27 8 2 2 34 5 0 0 Low 16 9 6 8 14 7 6 12 -
a Scores: 0, none; 1, mild; 2, moderate; and 3, severe stenosis.
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N κa 95% CI P Full scale (0–3) Overall 234 0.54 0.44–0.64 <.001 Left 117 0.51 0.36–0.65 <.001 Right 117 0.57 0.43–0.71 <.001 Upper 78 0.65 0.48–0.78 <.001 Mid 78 0.58 0.34–0.76 <.001 Lower 78 0.17 −0.05–0.38 .062 Dichotomized (normal [0] versus abnormal [1–3])b Overall 234 0.55 0.44–0.66 <.001 Left 117 0.49 0.32–0.65 <.001 Right 117 0.61 0.45–0.74 <.001 Upper 78 0.67 0.44–0.85 <.001 Mid 78 0.60 0.36–0.80 <.001 Lower 78 0.13 −0.09–0.35 .120 -
a Weighted κ using squared discrepancies.
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b For the dichotomized scores, considering abnormal CV as a standard, sensitivity, 0.79 (95% CI, 0.71%–0.86%); specificity, 0.76 (95% CI, 0.67%–0.83%); PPV, 0.79 (95% CI, 0.71%–0.86%); and NPV, 0.76 (95% CI, 0.67%–0.83%).
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MRV CVa No Yes Total No 14 3 17 Yes 7 15 22 Total 21 18 39 -
a Considering CV with severe stenosis as a standard, sensitivity, 0.83 (95% CI, 0.58%–0.96%); specificity, 0.67 (95% CI, 0.43%–0.85%); PPV, 0.68 (95% CI, 0.45%–0.85%); and NPV, 0.82 (95% CI, 0.56%–0.95%).
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Scan Type Collateral Scorea Total 0 1 2 3 CV 23 17 27 11 78 MRV 6 23 33 16 78 Total 29 40 60 27 156 P = .002 by paired Wilcoxon test, MRV scores > CV scores -
a Scores: 0, none; 1, mild; 2, moderate; and 3, severe.
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N κa 95% CI P Full scale (0–3) Overall 78 0.30 0.09–0.50 .002 Left 39 0.42 0.10–0.66 .003 Right 39 0.17 −0.08 to 0.44 .096 Dichotomized (normal [0] versus abnormal [1–3])b Overall 78 0.18 −0.05 to 0.40 .012 Left 39 0.28 −0.08 to 0.65 .020 Right 39 0.11 −0.10 to 0.35 .148 -
a Weighted κ using squared discrepancies.
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b Scores: 0, none; 1, mild; 2, moderate; and 3, severe.
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