In November 2013, at the conference “Multiple Sclerosis and CCSVI: Scientific Evidence” held in Cremona, Dr. Raffaello Pagani delivered a highly anticipated presentation that captured the attention of both medical professionals and patients. With decades of expertise in vascular diagnostics and a commitment to innovation, Dr. Pagani unveiled a newly published study focusing on dynamic jugular vein analysis in MS patients diagnosed with CCSVI (Chronic Cerebrospinal Venous Insufficiency).
Una visione integrata e non invasiva
EcoColorDoppler was a key focus of the presentation, proposed as a sensitive and accurate diagnostic tool for evaluating venous abnormalities in patients with MS. Compared to magnetic resonance venography, EcoColorDoppler has demonstrated greater sensitivity in detecting defects within the jugular veins, although MRI remains useful for identifying collateral circulation.
The key concept repeatedly emphasized is that CCSVI is a congenital syndrome affecting the brain’s main venous drainage pathways: the internal jugular veins and the azygos vein. Among the detectable defects are valvular malformations, stenoses, and hypoplasias – meaning vessels with reduced caliber.
Il ruolo della postura e del movimento nella diagnostica
One of the study’s innovative aspects involves observing changes in the cross-sectional area of the jugular veins during head rotation. While traditional examinations were performed with the head in a neutral position, Dr. Pagani’s research team introduced a dynamic maneuver, having patients rotate their heads 90° to the side opposite the one being examined.
This simple rotation helps “stretch” the sternocleidomastoid muscle, reducing external compression on the jugular vein and enabling more accurate assessment of potential caliber increases and irregularities. The study confirmed that this rotation expands the vein’s cross-sectional area, particularly in subjects with meiopragic-type abnormalities—vessels prone to central compression due to structural weakness.
Una casistica senza precedenti
The study involved 313 patients with multiple sclerosis and 298 healthy control subjects, making it one of the largest studies available in the scientific literature on this topic. All MS patients met at least 2 of the 5 diagnostic criteria for CCSVI proposed by Professor Zamboni.
The findings were striking: 89.8% of MS patients in the study had CCSVI, compared to just 5.4% of healthy controls. In Dr. Pagani’s own case series, this correlation rose to 97–98% — the highest reported in CCSVI research to date.
Nuove tipologie morfologiche venose
A pivotal contribution of this study was the introduction of novel morphological classifications for internal jugular veins, supplementing existing categorizations:
Normal Veins: regular blood flow with standard morphology.
Veins with valvular defects: localized malformations in the J1 segment, such as septa, abnormal leaflets, or membranes.
Hypoplastic veins: vessels with a reduced caliber along their entire length.
Meiopragic veins: veins with a central hourglass-shaped narrowing, easily compressible.
Meiopragic veins with valve defects: a combination of both conditions.
These two findings represent a groundbreaking discovery, with a prevalence of 27.1% and 4.5%, respectively, among patients with multiple sclerosis. Notably, these morphologies were not observed in healthy individuals.
Implicazioni diagnostiche e terapeutiche
he diagnostic value of this classification is reflected in the positivity scores for Zamboni’s criteria. Veins showing only valve abnormalities often meet just two criteria, while mixed forms (hypoplasia + valve defects + meiopragia) typically meet four or five, indicating greater severity and complexity.
Another important finding concerns the frequency of meiopragic veins, which appears to be evenly distributed regardless of the duration of multiple sclerosis. This suggests a congenital origin rather than a secondary development linked to disease progression.
La correlazione con il collagene
An interesting aspect emerged from histopathology. Some studies have analyzed the connective tissue composition of venous walls, revealing an altered ratio between type I and type III collagen in patients with MS. This could help explain the increased laxity of the vessel walls and their susceptibility to morphological changes.
Il futuro della diagnosi e il ruolo dell’approccio dinamico
The dynamic approach, as suggested by Dr. Pagani, could become a standard in the ultrasound diagnosis of venous malformations. Simply rotating the head can reveal abnormalities that would otherwise remain undetected during a static evaluation.
At the same time, collaboration among various specialists — vascular surgeons, radiologists, neurologists, and physiotherapists — is essential for a comprehensive approach to CCSVI, not only in multiple sclerosis but also in other related conditions.
The Cremona conference marked an important milestone in advancing research on CCSVI. With scientific rigor and a strong focus on outreach, Dr. Pagani highlighted the critical role of venous morphology, the dynamic approach, and multidisciplinary collaboration for achieving effective and early diagnosis.
The data presented, combined with his personal case studies and the new venous classifications, represent an important step forward in deepening our understanding of the link between impaired venous outflow and multiple sclerosis.
