Doppler Ultrasound Examination of Multiple Sclerosis Patients and Control Participants: Inter-observer Agreement and Association with Disease

作者：Laukontaus S J^*; Kagayama T; Lepantalo M; Atula S; Farkkila M; Alback A; Inoue V; Tienari P; Venermo M

来源：European Journal of Vascular and Endovascular Surgery, 2013, 46(4): 466-472.

DOI：10.1016/j.ejvs.2013.07.003

• CCSVI
• Multiple sclerosis
• Doppler ultrasound
• Internal jugular vein

Objective: Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a major risk factor for multiple sclerosis (MS). The aim of this study was to assess inter-observer agreement between two ultrasound examiners and to compare findings in MS patients and control participants. %26lt;br%26gt;Methods: A prospective, blinded, controlled study of MS patients diagnosed within 2 years (MS %26lt;= 2, n = 39), patients diagnosed more than 10 years ago (MS %26gt; 10, n = 43) and age- and sex-matched control participants (n = 40). Ultrasound examinations were performed by two independent examiners. CCSVI criteria 1, 3, 4 and 5 as proposed by Zamboni were explored: (1) reflux in the internal jugular (IJV) and vertebral veins (VV), (3) IJV cross-sectional area (CSA) %26lt;= 0.3 cm(2), (4) absence of flow in IJV and VV, and (5) reverted postural control of venous outflow. %26lt;br%26gt;Results: Criteria 1, 4 and 5 were met in less than 10% of the MS patients and control participants as studied by both examiners. The level of inter-observer agreement was poor for all parameters except assessment of the CSA of IJV at the thyroid level. Findings meeting CCSVI criterion 3 (CSA %26lt;= 0.3 cm(2)) were observed in 18/40 (45%) of the control participants, in 24/37 (65%) of MS %26lt;= 2 patients (p = 0.09 vs. control participants) and in 30/43 (70%) of the MS %26gt; 10 patients (p = 0.022 vs. control participants). %26lt;br%26gt;Conclusions: The feasibility of the CCSVI criteria for common use is questionable because of low inter-observer agreement. Small-calibre IJVs meeting the CCSVI criterion 3 appear common in both Finnish control participants and MS patients, but the clinical significance of this finding is questionable.

• 出版日期2013-10