Developmental venous anomalies in patients with multiple sclerosis: is that a coincidence or an ancillary finding?
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ORIGINAL ARTICLE
Developmental venous anomalies in patients with multiple sclerosis: is that a coincidence or an ancillary finding? Irene Grazzini 1
&
Benedetta Calchetti 2 & Gian Luca Cuneo 3
Received: 23 April 2020 / Accepted: 16 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Purpose Developmental venous anomalies (DVAs) have been found to be more prevalent in patients with multiple sclerosis (MS). The aim of the study was to compare the prevalence of DVAs in a large population of patients with MS compared with controls and to investigate the correlation of 3D Fluid Attenuated Inversion Recovery (FLAIR) hyperintense signal abnormalities adjacent to DVAs between MS patients and controls having DVAs, as well as DVA potential role in differential diagnosis. Methods Between January 2001 and December 2019, 349 patients who met the McDonald criteria for MS diagnosis (249 females, 100 males, age range 18–70 years) were retrospectively included in the study. All patients and 340 age-matched healthy controls had brain MRIs performed on a 1.5 Tesla MR system. Two radiologists reviewed all images to identify DVAs; their presence was compared between the MS and control groups. Among the subjects having DVAs, age, gender, adjacent FLAIR anomalies, and DVA location were compared between the two groups. Results Fifty (14.3%) out 349 patients presented 51 DVAs (35 supratentorial and 16 infratentorial), in comparison to 21/340 (6.2%) controls (P = 0.0005). One patient showed 2 simultaneous DVAs, while 3 patients had coexisting pontine capillary telangiectasias. FLAIR white matter changes adjacent to DVAs were found in 46.2% of patients and in 28.1% of controls (P = 0.0001). Conclusions DVAs demonstrated a higher prevalence in the MS group in comparison to controls. We confirmed the association between DVAs and FLAIR anomalies in MS patients. However, currently there are no evidences that the presence of DVAs may be used in MS differential diagnosis. Keywords Multiple sclerosis . Magnetic resonance imaging . Developmental venous anomalies . Neuroinflammation . Central nervous system
Introduction Multiple sclerosis (MS) is the most frequent chronic inflammatory demyelinating disease in young adult leading to longterm disability [1]. Abnormal cranial venous drainage has been described to have a possible role in the etiopathogenesis of MS [2], but the so-called chronic cerebrospinal venous insufficiency (CCSVI) theory is a controversial entity and it
* Irene Grazzini [email protected] 1
Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
2
Department of Cardiology-Neurology, Section of Neurology, San Donato Hospital, Arezzo, Italy
3
Department of Radiology, Vesalio Institute, Grosseto, Italy
has widely been debunked as an underlying cause of MS demyelinating lesions [3–8]. However, the perivenular nature of demyelinating plaques in MS has been observed in many studies and in autopsy specimens [9]; in fact, demyelination occurs along the callosal-septal med
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