Venous Doppler is the most important measure for assessing the cerebral venous system. Doppler is a dynamic study, capable of venous assessment in both upright and supine positions. It has been proven that the venous pathway is dominant in the jugular veins in the supine position, with the dominant pathway changing to the vertebral venous plexus system in the upright position. However, the cerebral venous system has been investigated only in unrelated disease processes, e.g., venous thrombosis, due to the presumption that the cerebral venous system was not relevant to other disease processes.

Dr. Zamboni’s hypothesis is based on Doppler assessment of the following five Extracranial Venous Abnormality Criteria:

  1. Reflux present in an outflow pathway (IJV and/or VV) with the head at 0° and 90°
  2. Reflux propagated upward to the DCV’s and/or from the White Matter to the Sub-cortical Gray Matter
  3. High resolution B-mode evidence of proximal IJV stenosis and/or other B-mode anomalies
  4. Flow not Doppler-detectable in the IJV’s and/or VV’s despite numerous deep breaths
  5. Negative ΔCSA in the IJV

Two or more positive extracranial venous abnormality Criteria were highly sensitive and specific for diagnosis of multiple sclerosis per Zamboni et al.

The first clinical research trial in the United States was completed by the Buffalo Neuroimaging Analysis Center (BNAC). This trial has shown an association between Dr. Zamboni’s extracranial venous abnormality hypothesis and Multiple Sclerosis (MS).

The curriculum will provide a basic knowledge of Multiple Sclerosis and MRI/MRV in relation to Multiple Sclerosis, understanding of cerebral venous anatomy and function, comprehension of the concept of extracranial venous abnormalities, and Doppler assessment and interpretation for extracranial venous abnormalities as well as pitfalls and artifacts of extracranial venous abnormalities Doppler.  Incorporated into the Program are three sessions of hands-on training.

The training course will take place at the Buffalo Neuroimaging Analysis Center in Buffalo, NY.
The University at Buffalo  (UB) School of Medicine and Biomedical Sciences is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.


The UB School of Medicine & Biomedical Sciences designates this live activity for a maximum of 24.0 AMA PRA Category 1 Credit(s)TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

SDMS designates this activity for a maximum of 18.25 ARDMS CME’s.  Technologist’s credit value will depend on the attendance time at the program. This activity is tracked by SDMS CME tracker.

Topics covered during the presentations are intended to provide a solid overview of the use of Venous Doppler. Learning Objectives include the following:

  • Cerebrospinal Venous (CSV) Anatomy
  • CSV Anatomy on MRV
  • CSV Physiology
  • Overview of Multiple Sclerosis
  • Role of CSV Function in relation to MS
  • Importance of MRI and other instrumental methods in the diagnosis and prognosis of MS
  • Role of Ultrasound-Based Techniques in MS
  • Artifacts and Pitfalls in CSV Doppler Imaging
  • Assessment of normal cerebral venous Doppler cases
  • Assessment of cerebral venous Doppler anomaly cases
  • Ultrasound Unit controls for venous scanning
  • Interpretation of Doppler results
  • Dexterity for venous scanning
  • Hands on Scanning Session of Normal Control Subjects
  • Hands on Scanning Session of MS Subject
  • Hands on Scanning Session of Blinded Case Subjects

List of participants, who have successfully completed Phase I and Phase II of the CVFAP training program can be seen here.

For registration form, dates and information click here. For questions, please e-mail venous.function@bnac.net or call 716-859-7040.