Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

Abstract

Objective

To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population.

Materials and methods

We prospectively recruited 100 patients without MS, aged 18–60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins.

Results

Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon.

Conclusion

It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients.

Key Points

The venous anatomy of the neck in patients without MS demonstrates multiple variants

Asymmetry and stenoses of the internal jugular veins are common

Collateral neck veins are not uncommon in patients without MS

These findings do not support the theory of chronic cerebrospinal venous insufficiency

MR venography is a useful imaging modality for assessing venous anatomy

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Acknowledgments

The scientific guarantor of this publication is Dr. Carlos Torres. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study was supported through an Operating Grant from the Multiple Sclerosis Society of Canada, regarding CCSVI and its relation to multiple sclerosis (MS). Rebecca Thornhill and Matthew Hogan kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, observational, performed at one institution.

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Correspondence to Carlos Torres.

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Torres, C., Hogan, M., Patro, S. et al. Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?. Eur Radiol 27, 239–246 (2017). https://doi.org/10.1007/s00330-016-4314-6

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Keywords

  • Neck
  • Venous anatomy
  • Internal jugular veins
  • Stenosis
  • Contrast-enhanced MR venography