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Open Access Highly Accessed Review

The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants

Kresimir Dolic12, Adnan H Siddiqui3, Yuval Karmon3, Karen Marr1 and Robert Zivadinov1*

Author Affiliations

1 Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High St., Buffalo, NY 14203, USA

2 Department of Radiology, University Hospital Center Split, University of Split, Spinciceva 1, Split 21000, Croatia

3 Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, 100 High St., Buffalo, NY 14203, USA

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BMC Medicine 2013, 11:155  doi:10.1186/1741-7015-11-155

Published: 27 June 2013


The extra-cranial venous system is complex and not well studied in comparison to the peripheral venous system. A newly proposed vascular condition, named chronic cerebrospinal venous insufficiency (CCSVI), described initially in patients with multiple sclerosis (MS) has triggered intense interest in better understanding of the role of extra-cranial venous anomalies and developmental variants. So far, there is no established diagnostic imaging modality, non-invasive or invasive, that can serve as the “gold standard” for detection of these venous anomalies. However, consensus guidelines and standardized imaging protocols are emerging. Most likely, a multimodal imaging approach will ultimately be the most comprehensive means for screening, diagnostic and monitoring purposes. Further research is needed to determine the spectrum of extra-cranial venous pathology and to compare the imaging findings with pathological examinations. The ability to define and reliably detect noninvasively these anomalies is an essential step toward establishing their incidence and prevalence. The role for these anomalies in causing significant hemodynamic consequences for the intra-cranial venous drainage in MS patients and other neurologic disorders, and in aging, remains unproven.

Multiple Sclerosis; CCSVI; Jugular Vein Reflux; Doppler Sonography; Magnetic Resonance Venography; Computed Tomography Venography; Catheter Venography; Intravascular Ultrasound; Plethismography; Multimodal Imaging