Robert Zivadinov
After it was hypothesized that chronic cerebrospinal venous insufficiency (CCSVI) is unique to patients with MS, interest spiked and treatments were sought by and provided to patients around the world. The patient risks and rewards became palpable, yet they have been supported primarily with media-reported anecdotes about both the science itself as well as patient outcomes.
First, we must agree on our definition of diagnostic success; we must define and validate the spectrum of cranial/extracranial venous anomalies and establish reliable diagnostic gold standard tests. Doing so will require multimodal studies and improved test operator training. We must close the yawning gap in CCSVI prevalence estimates that range from 0 to 100 percent, depending on the population, the methodology, the criteria, and the imaging technique. Because of the complexity of the intracranial and cervical venous systems, it is almost impossible during testing to take all of the key factors into account, regardless of which single imaging modality is used. Therefore, a multimodal imaging approach is necessary.
We have been contacted by a number of authors who understand the importance of using multimodal imaging for detection of venous abnormalities indicative of CCSVI and who have encouraged us to continue our work.
We expanded this research recently by performing another study in which we investigated the value of catheter venography and intravascular ultrasound in detecting venous abnormalities indicative of CCSVI. At the