Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis M. H. AL-OMARI, L. A. ROUSAN Radiology Department, King Abdullah University Hospital, Jordan University of Science and Technology, Jordan Aim. The aim of this study is to compare the hemodyna- mics and the morphology of the internal jugular veins using Colour-Doppler and B-mode sonongraphy in multiple scle- rosis patients (MS) and in controls. Methods. The internal jugular veins of 25 MS patients and 25 controls were examined using colour Doppler and B- mode ultrasound in sitting and supine positions, recording the changes in hemodynamics and the presence or absen- ce of morphological changes. The presence of at least two of the extracranial Zamboni criteria in the same individual was considered positive for evidence of chronic cerebro- spinal venous insufficiency (CCSVI). Results. According to the described criteria, 92% of the MS patients showed abnormal findings and 84% of them showed evidence of CCSVI, however; only 24% of controls showed abnormal findings, but none of them showed evidence of CCSVI (OR=7.25, 95% CI 2.92-18.01, P<0.0001). Conclusion. Hemodynamic abnormalities and morphologi- cal changes involving the internal jugular vein are strongly associated with MS. These findings can be demonstrated by a non-invasive, cost effective Doppler ultrasound criteria. [Int Angiol 2010;29:115-20] Key words: Jugular veins - Hemodynamics - Multiple scle- rosis. Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous sys- tem. Recent studies have suggested that MS is highly associated with a condition known as chronic cerebrospinal venous insufficiency (CCSVI) which is only seen in MS patients and not in patients who suffer neither from other neurodegenerative disorders nor in healthy indi- viduals. 1, 2 CCSVI is a condition which is recent- ly described and characterized by multiple areas of stenosis of the extracranial venous draining pathways, 3 namely the internal jugular veins and the Azygus veins, with collateral formation. 4 The normal venous drainage pathway of the blood leaving the brain is via the internal jugular veins and the vertebral veins; the former is favored in the supine posture and the latter in the upright position. The Azygus vein is the main route for venous drainage of the spinal cord. 1, 2 CCSVI can be easily assessed using Doppler sonography, 1, 2, 5 by evaluating the extracerebral venous hemody- namics with changes in posture, and to assess the morphology of the venous system in patients with MS. The aim of this paper is to compare the hemo- dynamics and morphology of the jugular veins using Colour-Doppler and B-mode sonography in MS patients and in controls. Materials and methods This is a sample for an ongoing study. We are still recruiting more patients and controls. This study was approved by Institutional Review Board (IRB) at Jordan University of Science and Tech- nology. Patients were self referred, controls were recruited from hospital staff or from patient referred for other unrelated ultrasound examina- tions. Twenty five patients (female: male 13:12), with clinically proven MS according to modified McDonald criteria 6 and 25 healthy age and gen- der matched controls underwent ultrasound for the internal jugular veins (Table I). Tewnty-one patients (84%) were relapsing remitting MS and 4 patients (16%) were secondary progressive MS. Non of the examined patients were primary pro- gressive MS. The examination was performed using a high frequency probe (4-7 MHz) using Vol. 29, No. 2 INTERNATIONAL ANGIOLOGY 115 Acknowledgments.—This project was supported by the dean- ship of research at Jordan University of Science and Techno- logy. Authors would like to thank Doctor Y S Khader for his assi- stance in the statistical analysis, and Doctor Mai N Al-Ali for her clinical assistance. Received on February 24, 2010; accepted for publication on March 9, 2010.