I think that that is a very fair question, SaintLouis. I showed reflux in both of my IJVs at GU. And they found bilateral stenosis during the venogram.
I know of a patient who only showed reflux in right IJV in a GU ultrasound. During this person's recent liberation they found moderate stenosis on the right, and SIGNIFICANT stenosis in two places in the LEFT. The US missed it entirely!
I am now even more skeptical of the ability of US to genuinely detect stenosis. My doc already doubts the accuracy of MRV due to the high incidence of artifacts.
I am starting to believe that as more veongrams are done, the numbers of MSers with stenosis is going to stay over 90%. Then the only evidence a doc will need to justify venogram is a positive MS dx.
I haven't seen a bill yet, but I bet that the venogram still costs less than 6 months worth of CRABs!
Just my humble opinion.