An Assessment of Chronic Cerebrospinal Venous Insufficiency in MS (P05.177)

OBJECTIVE: To conduct an independent assessment of chronic cerebrospinal venous insufficiency (CCSVI) in MS. BACKGROUND: CCSVI is a hypothesis of MS pathogenesis related to venous outflow from the head, with conflicting results from different studies. Recent studies have found a very low prevalence of CCSVI, suggesting that those investigators were performing ultrasound assessments differently than the original reports. DESIGN/METHODS: After obtaining formal training in CCSVI ultrasound techniques, we performed ultrasound assessments on a group of 61 MS subjects (4 CIS, 28 RRMS, 19 SPMS, 10 PPMS; 42 females) and 20 non-MS controls (15 healthy and 5 other neurological diseases; 10 female). Ultrasonographers were blinded to diagnosis, and separate research staff positioned subjects prior to ultrasonographer arrival. Assessments were performed using a Biosound MyLab25, equipped with Quality Doppler Profiles (QDP) technology, and traditional transcranial Doppler. Two published interpretations of CCSVI Criteria were utilized: Narrow Criteria did not include either B-mode intraluminal abnormalities or QDP technology for deep cerebral vein reflux, while Broad Criteria included both of these. RESULTS: Using either Narrow Criteria or Broad Criteria, there were no significant differences between MS subjects and controls (p>0.5 for both comparisons). In both groups, there was a doubling of the proportion of subjects meeting CCSVI criteria when using the Broad Criteria. CONCLUSIONS: Using trained and blinded ultrasonographers and QDP technology, we observed no difference in the proportion of MS subjects meeting CCSVI criteria compared to non-MS controls. Different interpretations of CCSVI criteria altered the proportions of subjects meeting CCSVI criteria, highlighting the importance of criteria interpretations when comparing the prevalence of CCSVI between studies. These observations do not support a significantly increased prevalence of CCSVI in MS and suggest against a pathogenic role of CCSVI in MS. Supported by: Research grant from National MS Society (RC 1004-A-5). Disclosure: Dr. Fox has received personal compensation for activities with Avanir, Biogen Idec, EMD Serono, and Novartis. Dr. Fox has received research support from Biogen Idec and Genentech. Dr. Baus has nothing to disclose. Dr. Diaconu has nothing to disclose. Dr. Grattan has nothing to disclose. Dr. Ivancic has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Lu has nothing to disclose. Dr. Raber has nothing to disclose. Dr. Ramesh has nothing to disclose. Dr. Rae-Grant has received personal compensation for activities with Novartis, Biogen Idec and Teva Neurosciences as a speaker.