What is the role of ultrasonography in the evaluation of multiple sclerosis (MS)?

Updated: Mar 27, 2019
  • Author: James A Wilson, MD, MSc, FRCPC; Chief Editor: James G Smirniotopoulos, MD  more...
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Ultrasonography is not currently used in the investigation of MS. Berg et al, however, used transcranial sonography to determine the size of the ventricles in patients with MS and found that an increasing size is correlated with the MRI-determined brain volume, as well as with cognitive dysfunction and clinical disability. Further studies may establish a role for ultrasonography in the prognosis and treatment of patients with MS. [55]

According to Walter et al, in patients with MS, hyperechogenicity of the substantia nigra and lenticular nucleus correlates with more pronounced MRI T2 hypointensity, which is thought to reflect iron deposition, and a larger bilateral substantia nigra echogenic area is related to a higher rate of disease progression. In addition, a small echogenic area predicts a disease course without further progression over 2 years. [56]  Walter et al performed the study to determine whether transcranial ultrasonography can identify lesions in deep gray matter in patients with MS and whether such findings can identify the severity and progression of MS. Of 75 patients followed, abnormal hyperechogenicity of the substantia nigra occurred in 41%; of the lenticular nucleus, in 54%; of the caudate nucleus, in 40%; and of the thalamus, in 8%, with similar frequency in patients with relapsing-remitting and primary or secondary progressive MS if corrected for disease duration.

Tromba et al used Italian researcher Paolo Zamboni’s ultrasound protocol, along with M-mode ultrasound, and found that about 60% of 112 patients with MS had venous insufficiency, [57] but in a Canadian study using catheter venography, Traboulsee et al found that only 1 of 65 patients (2%) with MS had extracranial venous narrowing. [58] The Canadian study also utilized the ultrasound criteria proposed by Zamboni and found that 35 of 79 (44%) MS patients met the criteria for cerebrospinal venous insufficiency. The Canadian researchers concluded that the ultrasound criteria are neither sensitive nor specific for narrowing on catheter venography. [58]

Macgowan et al looked at venous cerebral outflow in 26 MS patients and 26 controls using ultrasound and found no difference between the 2 groups. They also used phase-contrast MRI and found no significant difference in venous flow in the vertebral arteries, internal jugular veins, and epidural veins. [59]

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