I always assume that there is more than i can see. those just starting, more likely to miss things.
It is a familiar story, the group probably knows it by heart now.....the narrowing that was seen, was probably the impression of the carotid artery. it is usually a physiological narrowing caused by obstruction to flow further down. ..of course there are real narrowings there, including a muscle compression. But was IVUS done? how many views? was full strength contrast media used or diluted.
We should all assume there is more than meets the eye because the eye is not prepared to see everything.
I do not know where the impression that MRV is the standard came from? did your husband get a ultrasound ala zamboni?
I read your article in EV Today. Below is the quote which I think applies to my husband's scenario which is similar to what you mentioned above:
"As a result, many of the narrowings seen in CCSVI are caused by compression of a collapsed system by external forces rather than due to stenoses. This may lead to unnecessary angioplasty. The common areas of questionably physiological stenosis seen on MR venography are located at the skull base, adjacent to the carotid bulb, or where strap muscles exert compression."
I'm a physician (not radiology), so I have a descent understanding of anatomy, etc. What do you mean by "physiologic"? Do you mean clinically not significant or not pathological?
I discussed our venography result with our IR doctor, who is very experienced, although his experience is likely limited with CCSVI like most. He is quite sure, however, that the compression is not from the carotid. It is somewhere at the level of C1 so his feeling is that it may be the transverse process or ? the muscle (I watched the venogram, the compression was large, smooth border ~ 3-4 cm). When he balooned it, the jugular moved anteriorly. There was a 3-4 mmHg pressure gradient across the area of the compression which he considered significant give the venous system.
Any input you may have is greatly appreciated.
To your questions above, we did a straight venography, no IVUS, no doppler. There was no dilution of the contrast.
Thank you very much.