Brain Hyperechogenicities are not Associated with Venous Insufficiency in Multiple Sclerosis: A Pilot Neurosonology Study

• Published in: Journal of neuroimaging 2016-01, Vol.26 (1), p.150-155
• Main Authors: Krogias, Christos, Gold, Ralf, Chan, Andrew, Triantafyllou, Nikos, Voumvourakis, Konstantinos, Tsivgoulis, Georgios
• Format: Article
• Language: English
• Subjects: Accumulation; Adult; Basal ganglia; Blood-brain barrier; Brain - diagnostic imaging; Caudate nucleus; Chronic cerebro-spinal venous insufficiency; Criteria; Disintegration; Female; Ganglia; Humans; Hypotheses; Inflammation; Iron; iron accumulation; Lentiform nucleus; Male; Middle Aged; Multiple sclerosis; Multiple Sclerosis - diagnostic imaging; Neuroimaging; Nuclei; Parenchyma; Patients; Pilot Projects; Substantia nigra; Thalamus; transcranial sonography; Ultrasonography, Doppler, Transcranial; Ultrasound; Venous Insufficiency - diagnostic imaging
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.12248

ABSTRACT BACKGROUND AND PURPOSE The “venous hypothesis” of multiple sclerosis (MS) postulates that intracranial venous congestion disintegrates the blood‐brain barrier, resulting in iron accumulation in brain parenchyma triggering the inflammatory process of MS. Transcranial sonography (TCS) reveals brain parenchyma hyperechogenic alterations (BPHA) that are thought to reflect iron accumulation. We sought to investigate potential association of BPHA with chronic cerebrospinal venous insufficiency (CCSVI) in MS. METHODS MS patients were evaluated according to established TCS protocol for extrapyramidal disorders examining the presence of hyperechogenicities in different basal ganglia regions. Cerebral and cervical venous system was assessed according to proposed ultrasound protocol for CCSVI detection. RESULTS In a total of 32 MS patients (age = 40 ± 14 years; male = 41%; EDSS‐score = 3.1 ± 2.2) brain parenchyma hyperechogenic alterations were detected in twelve (38%) patients. The two sonographers agreed independently in 28 (87.5%) of the 32 examinations, resulting in a substantial to almost perfect agreement (Cohen's weighted kappa: substantia nigra = 0.904, Lentiform nucleus = 0.871, Thalamus = 0.784, caudate nucleus = 0.651). Two (6%) patients fulfilled the neurosonology criteria of CCSVI, while in 7 patients (22%) one positive criterion was detected. No BPHA were observed in any MS patient fulfilling CCSVI criteria. The prevalence of one positive CCSVI feature did not differ (P = .999) among patients with present (25%) or absent (20%) BPHA. CONCLUSION There was no association of BPHA with CCSVI findings. Our findings do not support the “venous hypothesis” resulting in iron accumulation even in the few MS patients fulfilling CCSVI‐criteria.