Magnetic Resonance Venography of chronic cerebrospinal venous insufficiency in patients with associated multiple sclerosis

BACKGROUND: Multiple sclerosis (MS) is a chronic disease with not well understood etiology. Recently, a possible association of MS with compromised venous outflow from the brain and spinal cord has been studied (chronic cerebrospinal venous insufficiency – CCSVI). Angioplasties of internal jugular veins (IJV) and azygous vein (AV) have given promising results, with improvements in patients’ clinical status. MATERIAL/METHODS: 830 patients with clinically defined MS were scanned from the level of sigmoid sinuses to the junction with brachiocephalic veins, as well as at the level of AV. T2-weighted, 2D TOF and FIESTA sequences were used. RESULTS: The examination revealed a slower blood flow in IJVs, in 98% of patients: on the right side – in 6%, on the left side – in 15%, on both sides with right-side predominance – in 22%, on both sides with left-side predominance – in 34%, bilaterally with no side predominance – in 19%. In 2%, there was a slower blood flow in IJVs, vertebral veins and subclavian veins and also in the left brachiocephalic vein. Moreover, in 5% of patients there was a decreased blood flow in the azygous vein. CONCLUSIONS: Abnormal flow pattern in IJVs is more common on the left side. Less often it can be found in azygous vein and in brachiocephalic veins. Further research is needed to investigate the significance of CCSVI in MS patients. The protocol we described can be used for most of modern magnetic resonance units.