IV – INVESTIGATIONS

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Systematic review of sonographic chronic cerebrospinal venous insufficiency findings in multiple sclerosis.

T. Lane (UK)

The relationship and prevalence of the chronic cerebrospinal venous insufficiency (CCVSI) and multiple sclerosis (MS) are still controversial. A systematic review of literature to identify the diagnostic accuracy and reproducibility for the Zamboni ultrasound (US) criteria for CCSVI has been performed. The inclusion criteria were cross-sectional methodology using the five Zamboni US criteria, MS diagnosed using McDonald criteria, age- and gender-matched healthy controls, and sonographer blinding.

Of 115 articles screened, 4 were included in the systematic review (Zamboni, 2009; Zivadinov, 2011, Centonze, 2011 and Baracchini, 2011). The diagnosis OR varies from 1.80 (0.9-3,6) to 26.499,0 (519,2-1.352,3), sensitivity from 0.07 (0.2- 0.16) to 1.00 (0.97-1.00), and specificity from 0.64 (0.94-1.00) to 1.0 (0.94-1.00), with a Cohen s kappa statistic of 0.75-0.93 (intra-sonographer) and 0.80 (intersonographer).

Studies disagree markedly on the prevalence and strength of the association between CCSVI and MS. No one has repeated the initially perfect diagnostic accuracy and each group appears to find different prevalence rates and odds ratios for CCSVI and MS. The results indicate that the sonographic findings are more variable than can be explained through biology alone and reflect subjectivity in the examination. There is no consistent evidence that sonographic CCSVI is ubiquitous in MS, or that it constitutes a useful clinical test for MS. Guidelines on the methodology of screening with ultrasound are urgently needed.

Classification of Duplex Scan findings after treatment of saphenous varicose veins

M. de Maseeneer (The Netherlands)

Treatment follow-up consists of four phases: immediate: 1-4 weeks, short-term: 1 year, mid-term: 3 years, and very long-term: 10 years. Medical reports had to include the following: vein diameter, absence or presence of reflux > 0.5 s, and localization of superficial epigastric vein (endovenous procedures). It is important to avoid terminology as: full success, partial success, no success.

References

Cavezzi et al. Eur J Vasc Endovasc Surg 2006;31: 288-99.
De Maeseneer M. et al. Eur J Vasc Endovasc Surg 2011;42:89-102.