Skip to main content
SpringerLink
Log in

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

  • Neuro
  • Published:
European Radiology Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Singh AV, Zamboni P (2009) Anomalous venous blood flow and iron deposition in multiple sclerosis. J Cereb Blood Flow Metab 29:1867–1878

    Article  CAS  PubMed  Google Scholar 

  2. Zamboni P (2006) The big idea: iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis. J R Soc Med 99:589–593

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zamboni P, Galeotti R, Menegatti E et al (2009) A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg 50:1348–1358, e1-3

    Article  PubMed  Google Scholar 

  4. Zamboni P, Galeotti R, Menegatti E et al (2009) Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 80:392–399

    Article  CAS  PubMed  Google Scholar 

  5. Hojnacki D, Zamboni P, Lopez-Soriano A et al (2010) Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls. Int Angiol 29:127–139

    CAS  PubMed  Google Scholar 

  6. Zamboni P, Menegatti E, Weinstock-Guttman B et al (2009) The severity of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis is related to altered cerebrospinal fluid dynamics. Funct Neurol 24:133–138

    CAS  PubMed  Google Scholar 

  7. Sundstrom P, Wahlin A, Ambarki K et al (2010) Venous and cerebrospinal fluid flow in multiple sclerosis: a case-control study. Ann Neurol 68:255–259

    Article  PubMed  Google Scholar 

  8. Cortes Nino MP, Tampieri D, Melancon D (2010) Endovascular venous procedures for multiple sclerosis? Mult Scler 16:771–772

    Article  Google Scholar 

  9. Doepp F, Paul F, Valdueza JM et al (2010) No cerebrocervical venous congestion in patients with multiple sclerosis. Ann Neurol 68:173–183

    Article  PubMed  Google Scholar 

  10. Stanbrook MB, Hebert PC (2010) Access to treatment for multiple sclerosis must be based on science, not hope. CMAJ 182:1151

    Article  PubMed  PubMed Central  Google Scholar 

  11. Niggemann P, Seifert M, Forg A et al (2012) Positional venous MR angiography: an operator- independent tool to evaluate cerebral venous outflow hemodynamics. Am J Neuroradiol 33:246–251

    Article  CAS  PubMed  Google Scholar 

  12. Schreiber SJ, Lurtzing F, Gotze R, Doepp F, Klingebiel R, Valdueza JM (2003) Extrajugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound. J Appl Physiol 94:1802–1805

    Article  PubMed  Google Scholar 

  13. Valdueza JM, von Munster T, Hoffman O, Schreiber S, Einhaupl KM (2000) Postural dependency of the cerebral venous outflow. Lancet 355:200–201

    Article  CAS  PubMed  Google Scholar 

  14. Escott EJ, Branstetter BF (2006) It's not a cervical lymph node, it's a vein: CT and MR imaging findings in the veins of the head and neck. Radiographics 26:1501–1515

    Article  PubMed  Google Scholar 

  15. Doepp F, Schreiber SJ, von Munster T, Rademacher J, Klingebiel R, Valdueza JM (2004) How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns. Neuroradiology 46:565–570

    Article  PubMed  Google Scholar 

  16. Rahman MT, Sethi SK, David T, Utriainen DT et al (2013) A comparative study of magnetic resonance venography techniques for the evaluation of the internal jugular veins in multiple sclerosis patients. Magn Reson Imaging 31:1668–1676

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zaharchuk G, Fischbein NJ, Rosenberg J et al (2011) Comparison of MR and contrast venography of the cervical venous system in multiple sclerosis. AJNR Am J Neuroradiol 32:1482–1489

    Article  CAS  PubMed  Google Scholar 

  18. Zivadinov R, Lopez-Soriano A, Weinstock-Guttman B et al (2011) Use of MR venography for characterization of the extracranial venous system in patients with multiple sclerosis and healthy control subjects. Radiology 258:562–570

    Article  PubMed  Google Scholar 

  19. McTaggart RA, Fischbein NJ, Elkins CJ et al (2012) Extracranial venous drainage patterns in patients with multiple sclerosis and healthy controls. AJNR Am J Neuroradiol 33:1615–1620

    Article  CAS  PubMed  Google Scholar 

  20. Sethi S, Utriainen DT, Daugherty AM et al (2015) Jugular venous flow abnormalities in multiple sclerosis patients compared to normal controls. J Neuroimaging 25:600–607

    Article  PubMed  Google Scholar 

  21. Zivadinov R, Bastianello S, Dake M et al (2014) Recommendations for multimodal noninvasive and invasive screening for detection of extracranial venous abnormalities indicative of chronic cerebrospinal venous insufficiency: a position statement of the international society for neurovascular disease. J Vasc Interv Radiol 25:1785–1794

    Article  PubMed  Google Scholar 

  22. Longley DG, Finlay DE, Letourneau JG (1993) Sonography of the upper extremity and jugular veins. AJR Am J Roentgenol 160:957–962

    Article  CAS  PubMed  Google Scholar 

  23. Valecchi D, Bacci D, Gulisano M et al (2010) Internal jugular vein valves: an assessment of prevalence, morphology and competence by Color Doppler Echography in 240 healthy subjects. Ital J Anat Embryol 115:185–189

    PubMed  Google Scholar 

  24. Lichtenstein D, Saïfi R, Augarde R (2001) The Internal jugular veins are asymmetric. Usefulness of ultrasound before catheterization. Intensive Care Med 27:301–305

    Article  CAS  PubMed  Google Scholar 

  25. Pucheu A, Evans J, Thomas D, Scheuble C, Pucheu M (1994) Doppler ultrasonography of normal neck veins. J Clin Ultrasound 22:367–373

    Article  CAS  PubMed  Google Scholar 

  26. Beddy P, Geoghegan T, Ramesh N et al (2006) Valsalva and gravitational variability of the internal jugular vein and common femoral vein: ultrasound assessment. Eur J Radiol 58:307–309

    Article  CAS  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Ottawa, Ottawa, ON, K1Y 4E9, Canada

    Carlos Torres, Satya Patro, Santanu Chakraborty, Thanh Nguyen, Rebecca Thornhill & Cheemun Lum

  2. Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada

    Carlos Torres, Satya Patro, Santanu Chakraborty, Thanh Nguyen, Rebecca Thornhill, Betty Anne Schwarz, Stefanie Belanger, Lysa Legault-Kingstone & Cheemun Lum

  3. Ottawa Hospital Research Institute OHRI, Ottawa, ON, Canada

    Carlos Torres, Matthew Hogan, Santanu Chakraborty, Thanh Nguyen, Rebecca Thornhill, Mark Freedman & Cheemun Lum

  4. Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Matthew Hogan & Mark Freedman

  5. Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada

    Matthew Hogan & Mark Freedman

  6. Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada

    Miguel Bussiere

  7. Department of Radiology, University of Saskatchewan, Neuroradiologist, Saskatoon, Canada

    Hamid Dabirzadeh

  8. Department of Radiology, Stony Brook School of Medicine, Stony Brook, NY, USA

    Mark Schweitzer

Authors
  1. Carlos Torres
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew Hogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Satya Patro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Santanu Chakraborty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thanh Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rebecca Thornhill
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mark Freedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Miguel Bussiere
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hamid Dabirzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Betty Anne Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Stefanie Belanger
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lysa Legault-Kingstone
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Mark Schweitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Cheemun Lum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Torres.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4314-6

Keywords

Search

Navigation