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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleBrain

Comparison of MR and Contrast Venography of the Cervical Venous System in Multiple Sclerosis

G. Zaharchuk, N.J. Fischbein, J. Rosenberg, R.J. Herfkens and M.D. Dake
American Journal of Neuroradiology September 2011, 32 (8) 1482-1489; DOI: https://doi.org/10.3174/ajnr.A2549
G. Zaharchuk
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N.J. Fischbein
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J. Rosenberg
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R.J. Herfkens
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M.D. Dake
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  • Fig 1.
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    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.

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    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.

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    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).

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    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).

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    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.

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    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).

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    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.

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    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

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    Table 1:

    Frequency of stenosis ratings by location and modality

    Scan Type and LocationSide and IJ Stenosis Scorea
    LeftRight
    01230123
    CV
        High108912811155
        Mid2618434320
        Low111288191082
    MRV
        High951411871410
        Mid2782234500
        Low16968147612
    • a Scores: 0, none; 1, mild; 2, moderate; and 3, severe stenosis.

    • View popup
    Table 2:

    Agreement of MRV and CV for IJ stenosis

    Nκa95% CIP
    Full scale (0–3)
        Overall2340.540.44–0.64<.001
        Left1170.510.36–0.65<.001
        Right1170.570.43–0.71<.001
        Upper780.650.48–0.78<.001
        Mid780.580.34–0.76<.001
        Lower780.17−0.05–0.38.062
    Dichotomized (normal [0] versus abnormal [1–3])b
        Overall2340.550.44–0.66<.001
        Left1170.490.32–0.65<.001
        Right1170.610.45–0.74<.001
        Upper780.670.44–0.85<.001
        Mid780.600.36–0.80<.001
        Lower780.13−0.09–0.35.120
    • a Weighted κ using squared discrepancies.

    • 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%).

    • View popup
    Table 3:

    Severe stenosis (grade = 3) in any IJ segment on a per-patient basis

    MRVCVa
    NoYesTotal
    No14317
    Yes71522
    Total211839
    • 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%).

    • View popup
    Table 4:

    Frequency of collateral scores

    Scan TypeCollateral ScoreaTotal
    0123
    CV2317271178
    MRV623331678
    Total29406027156
    P = .002 by paired Wilcoxon test, MRV scores > CV scores
    • a Scores: 0, none; 1, mild; 2, moderate; and 3, severe.

    • View popup
    Table 5:

    Agreement of collateral scores

    Nκa95% CIP
    Full scale (0–3)
        Overall780.300.09–0.50.002
        Left390.420.10–0.66.003
        Right390.17−0.08 to 0.44.096
    Dichotomized (normal [0] versus abnormal [1–3])b
        Overall780.18−0.05 to 0.40.012
        Left390.28−0.08 to 0.65.020
        Right390.11−0.10 to 0.35.148
    • a Weighted κ using squared discrepancies.

    • b Scores: 0, none; 1, mild; 2, moderate; and 3, severe.

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American Journal of Neuroradiology: 32 (8)
American Journal of Neuroradiology
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G. Zaharchuk, N.J. Fischbein, J. Rosenberg, R.J. Herfkens, M.D. Dake
Comparison of MR and Contrast Venography of the Cervical Venous System in Multiple Sclerosis
American Journal of Neuroradiology Sep 2011, 32 (8) 1482-1489; DOI: 10.3174/ajnr.A2549

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Comparison of MR and Contrast Venography of the Cervical Venous System in Multiple Sclerosis
G. Zaharchuk, N.J. Fischbein, J. Rosenberg, R.J. Herfkens, M.D. Dake
American Journal of Neuroradiology Sep 2011, 32 (8) 1482-1489; DOI: 10.3174/ajnr.A2549
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  • Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow
  • Phlebographic Study Does Not Show Differences Between Patients with MS and Control Subjects
  • Reproducibility of Cerebrospinal Venous Blood Flow and Vessel Anatomy with the Use of Phase Contrast-Vastly Undersampled Isotropic Projection Reconstruction and Contrast-Enhanced MRA
  • No Association Between Conventional Brain MR Imaging and Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis
  • Extracranial Venous Drainage Patterns in Patients with Multiple Sclerosis and Healthy Controls
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