Global and regional brain atrophy is associated with low or retrograde facial vein flow in multiple sclerosis

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Dejan Jakimovski
Karen Marr
Marcello Mancini
Maria Grazia Caprio
Sirin Gandhi
Niels Bergsland
Ivo Paunkoski
Jesper Hagemeier
Avinash Chandra
Bianca Weinstock-Guttman
Robert Zivadinov *
(*) Corresponding Author:
Robert Zivadinov |


Increased collateral facial vein (FV) flow may be associated with structural damage in patients with multiple sclerosis (MS). The objective was to assess differences in FV flow and magnetic resonance imaging (MRI)-derived outcomes in MS. The study included 136 MS patients who underwent neck and head vascular system examination by echo-color Doppler. Inflammatory MRI markers were assessed on a 3T MRI using a semi-automated edge detection and contouring/ thresholding technique. MRI volumetric outcomes of whole brain (WB), gray matter (GM), white matter (WM), cortex, ventricular cerebrospinal fluid (vCSF), deep gray matter (DGM), thalamus, caudate nucleus (CN), putamen, globus pallidus (GP), and hippocampus were calculated. Independent t-test and ANCOVA, adjusted for age, were used to compare groups based on FV flow quartiles. Thirty-four MS patients with FV flow ≤327.8 mL/min (lowest quartile) had significantly lower WB (P<0.001), WM (P<0.001), thalamus (P=0.004), cortex (P=0.004), GM (P=0.004), DGM (P=0.008), hippocampus (P=0.005), and GP volumes (P=0.044) compared to 102 patients with FV flow of >327.8 mL/min (higher quartiles). There were no differences in T1-, T2- and gadolinium- enhancing lesion volumes between the quartile groups. The lack of an association between FV blood flow and inflammatory MRI measures in MS patients, but an association with brain atrophy, suggests that the severity of neurodegenerative process may be related to hemodynamic alterations. MS patients with more advanced global and regional brain atrophy showed low or retrograde FV volume flow.


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