Original Communication

Journal of Neurology

, Volume 259, Issue 12, pp 2585-2589

First online:

CCSVI and MS: a statement from the European Society of neurosonology and cerebral hemodynamics

  • Claudio BaracchiniAffiliated withDepartment of Neuroscience, University of Padua Email author 
  • , José M. ValduezaAffiliated withNeurological Centre, Segeberger Kliniken
  • , Massimo Del SetteAffiliated withDepartment of Neuroscience, Ophthalmology and Genetics, University of Genoa
  • , Galina BaltgaileAffiliated withDepartment of Neurology, Latvian Medical Academy
  • , Eva BartelsAffiliated withCenter for Neurological Vascular Diagnostics
  • , Natan M. BornsteinAffiliated withDepartment of Neurology, Stroke Unit, Tel Aviv Sourasky Medical Center
  • , Juergen KlingelhoeferAffiliated withDepartment of Neurology, Medical Center Chemnitz
  • , Carlos MolinaAffiliated withHospital Val d’Hebron 119-129
  • , Kurt NiederkornAffiliated withDepartment of Neurology, Medical University Graz
    • , Mario SieblerAffiliated withDepartment of Neurology, Universitat Dusseldorf
    • , Matthias SturzeneggerAffiliated withDepartment of Neurology, University of Bern
    • , Bernd E. RingelsteinAffiliated withDepartment of Neurology, University of Munster
    • , David RussellAffiliated withDepartment of Neurology, Rikshospitalet, The National Hospital
    • , Laszlo CsibaAffiliated withDepartment of Neurology, Medical School, University of Debrecen

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To systematically review the ultrasonographic criteria proposed for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI). The authors analyzed the five ultrasonographic criteria, four extracranial and one intracranial, suggested for the diagnosis of CCSVI in multiple sclerosis (MS), together with the references from which these criteria were derived and the main studies that explored the physiology of cerebrospinal drainage. The proposed CCSVI criteria are questionable due to both methodological and technical errors: criteria 1 and 3 are based on a scientifically incorrect application of data obtained in a different setting; criteria 2 and 4 have never been validated before; criterion 2 is technically incorrect; criteria 3 and 5 are susceptible to so many external factors that it is difficult to state whether the data collected are pathological or a variation from the normal. It is also unclear how it was decided that two or more of these five ultrasound criteria may be used to diagnose CCSVI, since no validation of these criteria was performed by different and independent observers nor were they blindly compared with a validated gold-standard investigation. The European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) has considerable concerns regarding the accuracy of the proposed criteria for CCSVI in MS. Therefore, any potentially harmful interventional treatment such as transluminal angioplasty and/or stenting should be strongly discouraged.


CCSVI Ultrasound Multiple sclerosis