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Rastegari K, Mokhtari-Dizaji M, Harirchian MH, Hashemi H, Ayoobi Yazdi N, Saberi H. Biomechanical changes of the common carotid artery and internal jugular vein in patients with multiple sclerosis. Ultrasonography 2023; 42:100-110. [PMID: 36503209 PMCID: PMC9816705 DOI: 10.14366/usg.22053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/23/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Investigations of the hemodynamic changes of the venous system in patients with multiple sclerosis (MS) have shown contradictory results. Herein, the biomechanical parameters of the internal jugular vein (IJV) and common carotid artery (CCA) of MS patients were extracted and compared to healthy individuals. METHODS B-mode and Doppler sequential ultrasound images of 64 IJVs and CCAs of women including 22 healthy individuals, 22 relapsing-remitting multiple sclerosis (RRMS) patients, and 20 primary-progressive multiple sclerosis (PPMS) patients were recorded and processed. The biomechanical parameters of the IJV and the CCA walls during three cardiac cycles were calculated. RESULTS The IJV maximum and minimum pressures were higher in the MS patients than in the healthy subjects, by 31% and 19% in RRMS patients and 39% and 24% in PPMS patients. The venous wall thicknesses in RRMS and PPMS patients were 51% and 60% higher than in healthy subjects, respectively. IJV distensibility in RRMS and PPMS patients was 70% and 75% lower, and compliance was 40% and 59% lower than in healthy subjects. The maximum intima-media thicknesses of the CCAs were 38% and 24%, and the minimum intima-media thicknesses were 27% and 23% higher in RRMS and PPMS patients than in healthy individuals, respectively. The shear modulus of CCA walls in RRMS and PPMS patients was 17% and 31%, and the radial elastic moduli were 47% and 9% higher than in healthy individuals. CONCLUSION Some physical and biomechanical parameters of the CCA and IJV showed significant differences between MS patients and healthy individuals.
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Affiliation(s)
- Kimiya Rastegari
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Manijhe Mokhtari-Dizaji
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,Correspondence to: Manijhe Mokhtari-Dizaji, PhD, Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 1411713116, Iran Tel. +98-21-82883893 Fax. +98-21-88006544 E-mail:
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Imam Khomeini Hospital, Faculty of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Department of Radiology, Imam Khomeini Hospital, Faculty of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Ayoobi Yazdi
- Department of Radiology, Imam Khomeini Hospital, Faculty of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hazhir Saberi
- Department of Radiology, Imam Khomeini Hospital, Faculty of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Bateman GA, Lechner-Scott J, Carey MF, Bateman AR, Lea RA. Does the venous pressure theory of multiple sclerosis pathophysiology deserve a second chance? Mult Scler Relat Disord 2021; 56:103262. [PMID: 34537585 DOI: 10.1016/j.msard.2021.103262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/11/2021] [Indexed: 11/27/2022]
Abstract
The theory that multiple sclerosis is related to venous pressure has been discredited due to previous operator dependent diagnostic criteria and premature attempts at treatment. (1) An elevation in venous pressure may only be a component of the compliance changes found in MS. (2) The neck veins may only supply a component of the venous pressure elevation found intracranially. Although a more targeted approach towards neck angioplasty (both towards disease subtype and those with more favorable stenoses) may be beneficial, we would advocate caution. We encourage others to give the venous pressure theory a second chance and to replicate our work.
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Affiliation(s)
- Grant Alexander Bateman
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, Newcastle, NSW 2310, Australia; Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia.
| | - Jeannette Lechner-Scott
- Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Michael Fionn Carey
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, Newcastle, NSW 2310, Australia
| | | | - Rodney Arthur Lea
- Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, Australia
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Grazzini I, Calchetti B, Cuneo GL. Developmental venous anomalies in patients with multiple sclerosis: is that a coincidence or an ancillary finding? Neurol Sci 2020; 42:2453-2460. [PMID: 33083936 DOI: 10.1007/s10072-020-04840-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Developmental venous anomalies (DVAs) have been found to be more prevalent in patients with multiple sclerosis (MS). The aim of the study was to compare the prevalence of DVAs in a large population of patients with MS compared with controls and to investigate the correlation of 3D Fluid Attenuated Inversion Recovery (FLAIR) hyperintense signal abnormalities adjacent to DVAs between MS patients and controls having DVAs, as well as DVA potential role in differential diagnosis. METHODS Between January 2001 and December 2019, 349 patients who met the McDonald criteria for MS diagnosis (249 females, 100 males, age range 18-70 years) were retrospectively included in the study. All patients and 340 age-matched healthy controls had brain MRIs performed on a 1.5 Tesla MR system. Two radiologists reviewed all images to identify DVAs; their presence was compared between the MS and control groups. Among the subjects having DVAs, age, gender, adjacent FLAIR anomalies, and DVA location were compared between the two groups. RESULTS Fifty (14.3%) out 349 patients presented 51 DVAs (35 supratentorial and 16 infratentorial), in comparison to 21/340 (6.2%) controls (P = 0.0005). One patient showed 2 simultaneous DVAs, while 3 patients had coexisting pontine capillary telangiectasias. FLAIR white matter changes adjacent to DVAs were found in 46.2% of patients and in 28.1% of controls (P = 0.0001). CONCLUSIONS DVAs demonstrated a higher prevalence in the MS group in comparison to controls. We confirmed the association between DVAs and FLAIR anomalies in MS patients. However, currently there are no evidences that the presence of DVAs may be used in MS differential diagnosis.
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Affiliation(s)
- Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy.
| | - Benedetta Calchetti
- Department of Cardiology-Neurology, Section of Neurology, San Donato Hospital, Arezzo, Italy
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Hynes SM, Ghahari S, Forwell SJ. "Waiting for Science to Catch up with Practice": an examination of 10-year YouTube trends in discussions of chronic cerebral spinal venous insufficiency treatment for multiple sclerosis. Inform Health Soc Care 2019; 44:327-337. [PMID: 30913949 DOI: 10.1080/17538157.2019.1582052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this longitudinal study examined, first, whether people with multiple sclerosis who previously advocated for angioplasty to treat chronic cerebral spinal venous insufficiency (CCSVI) through YouTube continued reporting benefits. Second, it examined a new cohort reporting on CCSVI treatment, and third, whether perspectives have changed.Method: YouTube videos from August 2011 to January 2019 related to CCSVI were retrieved. Once retrieved, all videos were compiled, classified and analyzed. Categorical data were reported and a pre-determined code-book was used to code videos. Data from the videos were extracted and analyzed using discourse analysis.Results: 1293 videos related to CCSVI were uploaded by 54 people with multiple sclerosis who met the inclusion criteria. YouTube videos uploaded by people with multiple sclerosis have shifted in volume and message. The initial surge in interest in CCSVI treatment has diminished, but there still exists strong advocates for its use. There appears to be an inconsistency between positive results, actual improvements in symptoms, and the overall messages reported. Very little long-term data was available as the procedure is relatively new.Conclusion: Practitioners may be faced with pressure to provide unproven treatments in the future and should be understanding but evidence-driven when supporting multiple sclerosis therapies.
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Affiliation(s)
- Sinéad M Hynes
- Discipline of Occupational Therapy, College of Medicine, Nursing and Health Sciences, Áras Moyola, National University of Ireland, Galway, Ireland
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.,Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Susan J Forwell
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
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Sethi SK, Daugherty AM, Gadda G, Utriainen DT, Jiang J, Raz N, Haacke EM. Jugular Anomalies in Multiple Sclerosis Are Associated with Increased Collateral Venous Flow. AJNR Am J Neuroradiol 2017; 38:1617-1622. [PMID: 28546249 DOI: 10.3174/ajnr.a5219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE To date, research on extracranial venous collaterals has been focused on structure, with relatively little attention paid to hemodynamics. We addressed this limitation by quantitatively comparing collateral flow in patients with multiple sclerosis and healthy controls by using phase-contrast MR imaging. We hypothesize that patients with MS with structurally anomalous internal jugular veins will have elevated collateral venous flow compared with healthy controls. MATERIALS AND METHODS The sample consisted of 276 patients with MS and 106 healthy controls. We used MRV to classify internal jugular veins as stenotic and nonstenotic based on an absolute cross-sectional area threshold in 276 patients with MS and 60 healthy controls; 46 healthy controls lacked this imaging. Individual and total vessel flows were quantified by using phase-contrast MR imaging on all patients. Veins were classified by extracranial drainage type: internal jugular veins (I), paraspinal (II), and superficial (III). Differences among healthy controls, patients with MS, nonstenotic patients, and stenotic subgroups in total venous flow by vessel type were evaluated in a general linear model for statistical analysis. RESULTS In the MS group, 153 patients (55%) evidenced stenosis, whereas 12 (20%) healthy controls were classified as stenotic (P < .001). Compared with healthy controls, the MS group showed lower type I flow and increased type II flow. Stenosis was associated with reduced flow in the type I vessels [F(1272) = 68; P < .001]. The stenotic MS group had increased flow in the type II vessels compared with the nonstenotic MS group [F(1272) = 67; P < .001]. CONCLUSIONS Compared with healthy controls, patients with MS exhibit reduced venous flow in the main extracerebral drainage vein (internal jugular vein). In contrast, flow in the paraspinal venous collaterals is elevated in patients with MS and exacerbated by venous stenosis. Collateral drainage may be a compensatory response to internal jugular vein flow reduction.
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Affiliation(s)
- S K Sethi
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | | | - G Gadda
- Department of Physics and Earth Sciences (G.G.), University of Ferrara, Ferrara, Italy
| | - D T Utriainen
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | - J Jiang
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
| | - N Raz
- Institute of Gerontology (A.M.D., N.R.)
- Departments of Psychology (N.R.)
| | - E M Haacke
- From The MRI Institute for Biomedical Research (S.K.S., D.T.U., J.J., E.M.H.), Detroit, Michigan
- Radiology (E.M.H.), Wayne State University, Detroit, Michigan
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