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Table 2 Advantages and disadvantages of invasive 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

Invasive diagnostic methods Advantages Disadvantages
Catheter venography[28, 34, 42, 43, 4551] - considered gold standard - invasive method
- real time information can be obtained by using contrast - ionizing radiation
- ability to measure pressure - cannot be performed without contrast (allergy, toxicity)
- provide “road map” for planning endovascular procedures - operator dependent
- can be complemented by use of more sophisticated criteria (time to empty contrast from vein or wasting of the balloon) - time consuming (>45 minutes)
  - cannot detect intra-luminal abnormalities
- no global view of veins and collaterals
- no standardized definition of significant vein stenoses
Intravascular ultrasound[47, 107, 108] - offers a 360° view of the vessel’s wall from the inside - invasive method
- can detect intra-luminal abnormalities - lack of experience - no standardized protocols
- easily accesses all parts of IJVs in comparison with DS - ring down artifacts
- provides more accurate assessment of vein stenosis and wall thickness than CV and DS - geometric distortion - from imaging in an oblique plane
   - size of IVUS probe - limitation in the imaging of severe stenosis
  1. Legend: CV, catheter venography; DS, Doppler Sonography; IVUS, intravascular ultrasound.