Quantitative Flow Measurements in the Internal Jugular Veins of Multiple Sclerosis Patients Using Magnetic Resonance Imaging

Purpose: To study the blood flow through the internal jugular veins (IJVs) of the MS population. Materials and Methods: Two hundred MS patients and 14 normal volunteers were evaluated with magnetic resonance imaging (MRI) at 3T. Contrast-enhanced time-resolved 3D MR angiography and 2D time-of-flight imaging were performed to assess abnormalities in the extracranial vascular anatomy. Based on this assessment, the MS population was divided into subgroups of non-stenotic (NST), cervical 1 stenotic only (C1ST) and cervical 6 stenotic (C6ST) subjects. In this study, 2D phase contrast MR imaging was used to quantify blood flow through major veins and arteries in the neck and flow differences among the groups were analyzed. Results: Of the 200 MS patients, 87 (43.5%) belonged to the NST group, 50 (25%) belonged to the C1ST group and 63 (31.5%) belonged to the C6ST group. The total IJV flow normalized to the total arterial flow of the NST group was 75.12 ± 12.22 %. This was significantly higher than that of the C1ST group, 63.93 ± 16.08 % (p<0.0001), which in turn was significantly higher than that of the C6ST group, 52.13 ± 20.71 % (p = 0.001). Seventy-nine percent of the stenotic groups had a normalized subdominant IJV flow of less than 20%, a combined IJV flow of less than 50% and/or a sub-dominant IJV flow vs. dominant IJV flow ratio of less than 1/3. Only 2% of the NST group had a combined IJV flow of less than 50%, compared to 35% of the stenotic groups. Conclusion: Blood flow through the IJVs was reduced in the MS population with stenoses compared to those without. Keywords: Chronic cerebrospinal venous insufficiency, flow abnormalities, magnetic resonance imaging, multiple sclerosis, vascular abnormalities