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Table 1 Advantages and disadvantages of noninvasive diagnostic methods for diagnosis of chronic cerebrospinal venous insufficiency

From: The role of noninvasive and invasive diagnostic imaging techniques for detection of extra-cranial venous system anomalies and developmental variants

Noninvasive diagnostic methods Advantages Disadvantages
Doppler sonography[18, 27, 3032, 34, 78101] - noninvasive - no standardized guidelines
- without ionizing radiation - operator dependent
- less expensive - time consuming (60 to 120 minutes)
- high resolution - blinding procedures are challenging
- real time information - cannot perform global view of the veins (limited window)
- sensitive to detect flow changes, intra- and extra-luminal abnormalities - misidentification of the veins
- ability to measure velocity - influenced by hydration status
- possible control of respiratory phases  
Magnetic resonance venography[10, 30, 31, 34, 42, 43, 102] - noninvasive - no real time information
- without ionizing radiation - cannot detect intra-luminal abnormalities
- well established method - low specificity of conventional MRV techniques
- operator independent - influenced by hydration status
- less time consuming than DS - azygos vein examination needs technical improvements due to important artifacts (breathing, heart movements)
- provide global view of intra- and extra-cranial venous system - underestimates the vascular caliber
- easy to blind - “snapshot” nature
- ability to measure flow and velocity with advanced technique (phase contrast MRV)  
- global view of collateral veins
- can be performed without contrast (pregnancy, allergy)
Computed tomography venography[5, 103, 104] - noninvasive - ionizing radiation
- less expensive and time consuming than MRV - no real time information
- better spatial resolution than MRV - cannot detect intra-luminal abnormalities
- global view of veins - cannot be performed without contrast (allergy, toxicity)
- lack of experience for extra-cranial venous system - less contrast resolution than MRV
Plethysmography[105, 106] - noninvasive - higher false-positive rate due to venous compression arising from incorrect patient positioning or the action of extrinsic masses
- provides valuable information regarding the impact of reflux and obstruction on overall venous function - low resolution
  - can monitor the dynamics of venous disease over time and evaluation of treatment outcomes  
  1. Legend: DS, Doppler sonography; MRV, Magnetic Resonance Venography.