This Is MS Multiple Sclerosis Community: Knowledge & Support

Int Angiol. 2010 Apr;29(2):127-39.

Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls.
Hojnacki D, Zamboni P, Lopez-Soriano A, Galleotti R, Menegatti E, Weinstock-Guttman B, Schirda C, Magnano C, Malagoni AM, Kennedy C, Bartolomei I, Salvi F, Zivadinov R.

The Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA - rzivadinov@bnac.net.

AIM: Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of primary veins outside the skull that restrict normal outflow of blood from the brain. CCSVI was recently described as highly prevalent in patients with multiple sclerosis (MS), and can be non-invasively diagnosed by Doppler sonography (DS) and invasively by selective venography (SV). The aim of this paper was to investigate the value of neck magnetic resonance venography (MRV) for the diagnosis of CCSVI compared to DS and SV in patients with MS and in healthy controls (HC). METHODS: Ten MS patients and 7 HC underwent DS, 2D-Time-Of-Flight venography (TOF) and 3D-Time Resolved Imaging of Contrast Kinetics angiography (TRICKS). MS patients also underwent SV. The internal jugular veins (IJVs) and the vertebral veins (VVs) were assessed by both MRV sequences, and the findings were validated against SV and DS. SV has been considered the diagnostic gold standard for MS patients. RESULTS: All MS patients and none of the HC presented CCSVI, according to the DS criteria. This was confirmed by SV. For CCSVI diagnosis, DS showed sensitivity, specificity, accuracy, PPV and NPV of 100%, whereas the figures were 40%, 85%, 58%, 80% and 50% for 3D-TRICKS, and 30%, 85%, 52%, 75% and 46% for 2D-TOF in the IJVs. In MS patients, compared to SV, DS showed sensitivity, specificity, accuracy, PPV and NPV of 100%, 75%, 95%, 94% and 100%, whereas the figures were 31%, 100%, 45%, 100% and 26% for 3D-TRICKS and 25%, 100%, 40%, 100% and 25% for 2D-TOF in the IJVs. CONCLUSION: The use of MRV for diagnosis of CCSVI in MS patients has limited value, and the findings should be interpreted with caution and confirmed by other imaging techniques such as DS and SV.

PMID: 20351669 [PubMed - in process]


http://www.ncbi.nlm.nih.gov/pubmed/20351669

Thank you Erik. Great posts friend!

Int Angiol. 2010 Apr;29(2):158-75.

Chronic cerebrospinal venous insufficiency and iron deposition on susceptibility-weighted imaging in patients with multiple sclerosis: a pilot case-control study.
Zivadinov R, Schirda C, Dwyer MG, Haacke ME, Weinstock-Guttman B, Menegatti E, Heininen-Brown M, Magnano C, Malagoni AM, Wack DS, Hojnacki D, Kennedy C, Carl E, Bergsland N, Hussein S, Poloni G, Bartolomei I, Salvi F, Zamboni P.

Buffalo Neuroimaging Analysis Center, University at Buffalo, Buffalo, NY, USA - rzivadinov@bnac.net.

AIM: Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular phenomenon recently described in multiple sclerosis (MS) that is characterized by stenoses affecting the main extracranial venous outflow pathways and by a high rate of cerebral venous reflux that may lead to increased iron deposition in the brain. Aim of this study was to investigate the relationship between CCSVI and iron deposition in the brain of MS patients by correlating venous hemodynamic (VH) parameters and iron concentration in deep-gray matter structures and lesions, as measured by susceptibility-weighted imaging (SWI), and to preliminarily define the relationship between iron measures and clinical and other magnetic resonance imaging (MRI) outcomes. METHODS: Sixteen (16) consecutive relapsing-remitting MS patients and 8 age- and sex-matched healthy controls (HC) were scanned on a GE 3T scanner, using SWI. RESULTS: All 16 MS patients fulfilled the diagnosis of CCSVI (median VH=4), compared to none of the HC. In MS patients, the higher iron concentration in the pulvinar nucleus of the thalamus, thalamus, globus pallidus, and hippocampus was related to a higher number of VH criteria (P<0.05). There was also a significant association between a higher number of VH criteria and higher iron concentration of overlapping T2 (r=-0.64, P=0.007) and T1 (r=-0.56, P=0.023) phase lesions. Iron concentration measures were related to longer disease duration and increased disability as measured by EDSS and MSFC, and to increased MRI lesion burden and decreased brain volume. CONCLUSION: The findings from this pilot study suggest that CCSVI may be an important mechanism related to iron deposition in the brain parenchyma of MS patients. In turn, iron deposition, as measured by SWI, is a modest-to-strong predictor of disability progression, lesion volume accumulation and atrophy development in patients with MS.

PMID: 20351672 [PubMed - in process]

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Kitty says, "Take that, you stenosis!"

Got MS?.....Get Liberated!

I'm confused then. I know it's only 10 MS patients and 7 controls, but doesn't it cast some doubt on their 55%/25% study?

I'm confused too. How does this group play into the larger group they are studying? Is it a subset? How did diagnostics differ from the first 500 they released? Same ultrasound techs? Same training? I just don't know what to make of this. help

The 100% CCSVI in MS/0% in controls is what was found in Zamboni's research and the endovascular treatment study at Buffalo...this fits in well with those. No need to make it match Buffalo's larger study when we don't have the full information on that, plus there is always misdiagnosis of m.s. in people who actually have other diseases and inexperience at the time the research was done with testing for CCSVI that may have confounded the larger study somewhat...I think the salient point continues to be that people with m.s. have CCSVI as a much greater percentage than the normal population, whatever that percentage turns out to be.

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"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition

True enough, but there's a vast difference in terms of implications between 55% and > 90%.

Well, yes. My personal belief is that it's at the 90% figure, so I do my best to ignore the Buffalo findings.

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"However, the truth in science ultimately emerges, although sometimes it takes a very long time," Arthur Silverstein, Autoimmunity: A History of the Early Struggle for Recognition

Thanks for posting these studies. I had just talked my Neuro into ordering an MRV, but now that looks more like an expensive gamble. Rats. Finding a doppler technician with this special training is a much more difficult proposition. Too bad there isn't a simple how-to on YouTube, or is there?

Questions about the study comparing MRV, DS & SV that eric posted:

What is PPV?
What is NPV?
Sensitivity?

Specificity?

Accuracy?

It looks like it's a waste of money to get an MRV. Yet, Dake went from MRV directly to venography and treatment. MRVs are expensive and from this very small study possibly useless. Can we extrapolate from 10 MS patients that these results are global?

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Kat

Keep in mind they backed this up with invasive selective venography, SV. That didn't happen in the larger Buffalo study which was scanning only. This seems like a much smaller investigation into one method vs. the others or in combination. Feeling their oats so to speak.

Least that's my take on it..

Mark

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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

Nearly the same subject has been discussed as MRV questions:

http://www.thisisms.com/ftopict-10995.html

Is it possible for admin to put the threads together ?

Thanks if you can.
MarkW

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Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 10 years of study around MS.
Mark's CCSVI Report 7-Mar-11:
http://www.telegraph.co.uk/health/8359854/MS-experts-in-Britain-have-to-open-their-minds.html

It is not possible to merge two threads together. Nor is it possible to move posts from one thread into another. It is only possible to move either whole threads or individual posts from one forum to another, for example, from CCSVI to Antibiotics etc. However, when this is done with individual posts, a new thread in the receiving forum must be created.

NHE