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. Ultrasound and venographic studies of the internal jugular and azygos venous systems in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 71%, range 0-100%; n=1336) associated with activation of collaterals. By contrast, ultrasound and venographic examinations of normal controls and patients without MS have demonstrated a much lower prevalence (mean 7.1%, range 0-22%; n=505). Ultrasound in the form of duplex scanning 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 of obstructive lesions, ranging from 62% to 100%, has been found by some teams in patients with MS compared with a low prevalence (0-25%) in controls. However, others have reported absence of these lesions or a lower prevalence (16-52%). This variability could be the result of differences in technique, training, experience or criteria used. In order to ensure a high reproducibility of duplex scanning with comparable accuracy between centers a detailed protocol with standard methodology and criteria is needed. Also, standardization of the method of reporting of duplex measurements and other findings will facilitate validation of the proposed criteria by different centers. The aim of this document is to produce recommendations for such a protocol and indicate what future research is needed in order to address areas of uncertainty.

译文

:慢性脑脊髓静脉功能不全(CCSVI)是一种综合征,其特征是颈内和/或合子静脉狭窄或阻塞,血流不畅,并形成侧支静脉通道。患有多发性硬化症(MS)的患者的颈内静脉和合子静脉系统的超声和静脉造影研究表明,CCSVI的患病率很高(平均值为71%,范围为0-100%; n = 1336),与侧支的激活相关。相比之下,正常对照和无MS患者的超声和静脉造影检查显示患病率要低得多(平均7.1%,范围为0-22%; n = 505)。双工扫描形式的超声结合了生理学测量和解剖学成像,已被不同中心用于检测CCSVI,结果各不相同。一些研究小组发现,MS患者阻塞性病变的患病率较高,范围从62%到100%,而对照组的患病率较低(0-25%)。但是,其他人则报告没有这些病变或患病率较低(16-52%)。这种差异可能是所使用的技术,培训,经验或标准不同的结果。为了确保在各个中心之间具有相当的准确性的双面扫描具有很高的重现性,需要使用标准方法和标准的详细协议。同样,双相测量和其他发现的报告方法的标准化将有助于不同中心对提议标准的验证。本文档旨在为此类协议提供建议,并指出需要进行哪些进一步的研究以解决不确定性领域。

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