Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound - Recommendations for a protocol

P. Zamboni, S. Morovic, E. Menegatti, G. Viselner, A. N. Nicolaides, D. Neuhardt, M. B. Griffin, C. Setacci, A. Cavezzi, B. B. Lee, P. Thibault, G. Andreozzi, M. Al-Omari, S. Bastianello, C. B. Beggs, P. Cecconi, V. Demarin, C. Franceschi, A. Galassi, E. M. HaackeA. Lagace, N. Liasis, T. Ludyga, M. Lugli, O. Maleti, M. Mancini, M. Marinoni, K. Marr, S. McDonald, N. Morrison, F. Salvi, S. Sclafani, A. Scuderi, S. Shepherd, M. Simka, A. Stella, R. Zivadinov

Research output: Contribution to journalArticlepeer-review


Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses or obstructions of the internal jugular and/or azygos veins with disturbed flow and formation of collateral venous channels. Studies using ultrasound in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 70%; range 0-100%; N.=1496), whereas, in normal controls and patients without MS the prevalence was much lower (mean 10%; range 0-36%; N.=635). Ultrasound uses a combination of physiological measurements as well as anatomical imaging and has been used for the detection of CCSVI by different centers with variable results. A high prevalence ranging from 62% to 100% of obstructive lesions has been found by some teams in patients with MS compared with a lower prevalence of 0-25% in controls. However, absence of such lesions or a lower prevalence (16-52%) has been reported by others. This variability could be the result of differences in technique, training, experience or criteria used. The current lack of a methodology shared among experts is a confounding element in epidemiologic studies, and does not permit further Bayesan or other kind of analysis. In order to ensure a high reproducibility of Duplex scanning with comparable accuracy between centers, a detailed protocol with standard methodology and criteria is proposed. This is also necessary for training. It has been shown that inter-rater variability increases post-training (from k=0.47 to k=0.80), while within-rater reproducibility in trained operators was k=0.75. Finally, the consensus document proposes a reporting standard of Duplex measurements, and future research to answer areas of uncertainty.

Original languageEnglish
Pages (from-to)571-597
Number of pages27
JournalInternational Angiology
Issue number6
Publication statusPublished - Dec 2011


  • Constriction, pathologic
  • Ultrasonography
  • Venous insufficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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