Pascal Niggeman
The concept of CCSVI challenged the established theories for the development and progression of MS. The data that support CCSVI are discussed controversially, mainly due to the fact that CCSVI can only be diagnosed using Duplex ultrasound (DUS), which is an operator-dependent modality. DUS is the sole method to evaluate a patient in regard to CCSVI because it is, up to now, the only modality to provide positional information. Examinations performed solely in the supine position, such as conventional MR imaging, are considered to be of little use.
While performing research on spinal pathology using positional MR imaging, we noticed that the vertebral venous plexus was much more prominent when performing the examinations in an upright position, and we came up with the idea to image the cerebral outflow tract in different positions. First, we published a paper on the impact of positional anatomy on the imaging of the cervical spine and only then thought to develop a 3D venous MRA sequence, which might be useful to clarify the CCSVI theory. We think a non-user-dependent method providing information about the cerebral venous outflow tract might be more objective than DUS and helpful in further evaluating the concept of CCSVI.
The comments on our work have been largely positive; however, it has been pointed out that further research is necessary before it is possible to thoroughly evaluate the possibilities of positional venous MR angiography. Mainly the lack of correlation with DUS is considered a problem to clinically use positional venous MRA.