This gets tossed around so much, it needs it's own sticky. It depends on the situation, always. On the patient, the testing protocol, the tech, the insurance and a raft of other issues. Maybe they catch the reflux on UT, maybe not, maybe on MRV they can identify stenosis, maybe not, but I highly doubt any of us can just get a venogram on demand, I think one person did it, the rest need to explore MRV or CT or UT first. If one can get a UT, and the tech can easily identify the reflux, then no, an MRV at that point would be redundant and unnecessary.
If however, the UT is negative, that may, or may not mean much of anything if the proper protocols are not followed, or if the stenosis and resultant reflux is inaccessible to that imaging method. In that case, the few options left are MRV, or the CT version of that, or a venogram, but a venogram is invasive and usually accomplished in an operative setting with some anticipation of a surgical intervention.
It cannot be stressed enough, that just because one method works for one person, doesn't mean it automatically holds true for everyone else. I think anyone that can get the Dx and surgical intervention based solely on UT, has just leapfrogged over a lot of headache and expense!
I think some stenosis and reflux is right there in the middle of the neck or a bit lower and easy to detect, and others are not so easy.
Well done anyways!
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko
, Virtually symptom free since, no relap