MRV Question?

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

MRV Question?

Postby CureOrBust » Sun Apr 04, 2010 12:14 am

Can anything be read into the images of an MRV based on how "brightly" a vessels displays, in relation to other vessels?

For example, looking at my MRV, I see that a certain vein appears considerable more transparent than anything else in the image. It is like this in every image :? (the image is wide, so I have it as a link http://i81.photobucket.com/albums/j212/CureOrBust/SubclavianVeins.png)

And while I am here :) does anyone know what the exposure time is roughly on every frame? are we talking milliseconds or seconds?
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Postby Johnson » Sun Apr 04, 2010 1:18 am

Wow! Nice pic.

To my understanding, the gadolinium contrast agent should make the blood vessels "light up", and the darker areas can indicate a lack of blood flow. I am sure that is simplistic, but it makes sense to me. In my own images, the veins are dark at the strictures, and in areas below. It looks as if a big collateral is coming of your RIJV there too.

I am building the understanding that IJV strictures are likely caused by strictures lower down - IE: at the sub-clavian plexus, where the IJVs, innominate - or brachio-cephalic - veins, join to form the superior vena cava. Forgive me if my recollection of anatomy be skewed, I have been drinking the red, in order to inhibit iron uptake.
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Postby CureOrBust » Sun Apr 04, 2010 3:14 am

Johnson wrote:Wow! Nice pic.
Thats what you get with a 3T MRI machine. It was one biiiig mumma.

Johnson wrote:To my understanding, the gadolinium contrast agent should make the blood vessels "light up", and the darker areas can indicate a lack of blood flow. I am sure that is simplistic, but it makes sense to me.
That's what I would of assumed in my non trained way of thinking. But I am a little confused as to why the trained personel who looked at the images would not have noted it. The thing I think makes it a little more confusing, are that these 3D projections are actually built up by the computer, from the many slices taken during the MRI; ie they are a derived image. When i spoke to the radiologist, he said I should go to the source slices when looking for specifics (fine for him with his medical degree :oops: ) I wanted to check before I sent him an email with any specific question.
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Latest Paper from Zamboni et al

Postby MarkW » Sun Apr 04, 2010 6:51 am

Hello CureOrBust,
Sorry to be the bearer of bad news but the latest paper from Zamboni et al warns against MRV:
PAPER (abstract on csvi.net):
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
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 Doppler sonography (DS) and selective venography (SV).

Kind regards,
MarkW
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 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
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Postby silverbirch » Sun Apr 04, 2010 7:39 am

Markw

Hi there may I ask for your take on EHClinic research they are useing doppler and believe no other electronic equipment.

Im booked for 9th July Glasgow

Kindest regards
Silver
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Prof Zamboni writes:

Postby MarkW » Sun Apr 04, 2010 10:23 am

Hello Silver,
I quote Prof Z words:
- 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.
- SV has been considered the diagnostic gold standard for MS patients.

The EH Clinic is using DS by a technician trained in Italy. My take is: on the 9th July you will know if you have CCSVI or not. I have not seen the treatment offering from EHC but would expect that to include selective venography and balloon venoplasty.

Remember DS is non invaisive and cheaper than SV. It is entirely logical to start with a non invasive test.

Best wishes for the 9th.

MarkW
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 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
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Postby WeWillBeatMS » Sun Apr 04, 2010 1:22 pm

MarkW,

With all due respect, sincerely, don't you think it's rather early to discount MRV? Certainly Dr. Zamboni is the giant in the room having discovered CCSVI out of nothing more than a labor of love aimed first at his beloved wife and now continues his fight for the rest of the MS community. Having said that though, it seems there are physicians and research doctors that are stepping forward and embracing Dr. Zamboni's work and research and hopefully even trying to stand on the shoulders of this giant of a man and hero to those of us suffering with MS. So if Dr. E. Mark Haacke and Dr. Zivadinov indicate that MR is useful in attempting to diagnose CCSVI, should we be quick to discount it just because Dr. Zamboni says it only has limited value?

From www.ms-mri.com FAQ #14:

"The current CCSVI MRI protocol that Dr. Zivadinov reported includes both MRV and flow quantification. MR flow quantification is as good as and perhaps even better than ultrasound. With these two features together, MR can catch a lot of the abnormal vessels. Further, MRI can create full 3D vascular information from the aortic arch to the top of the brain. Doppler is also more operator dependent than the MRI. But ultrasound can image the valves and septum in the veins which MRI can not do. So together they make a good combination with flow acting as a common link between them. In summary, both ultrasound and MRI are very important. As in any technological applications, imaging methods will only get better over time and our ability to diagnose CCSVI will get better. The imaging methods only suggest CCSVI. MRI is a critical assessment tool, especially from the neurological perspective. MRI can measure atrophy, iron content and if the veins are patent."

Especially for now in the early phases when Doppler Ultrasound is very operater dependent, it's easy for the technician to do the test and totally miss CCSVI because it can be slippery to catch it seems.

The two ultrasound technicians that I had for my transcranial doppler had never heard of CCSVI, which is not surprising, and I was not prepared with the correct protocol so I am trying to get my neurologist to retry the test. But now I am scheduled for my first MRV in 5 days. I will certainly be prepared with the protocol from Dr. Haacke.

On a different topic, I would like your opinion if I may ask for it. The day before my MRV I am scheduled to start on Tysabri once again. I was on Tysabri last year for six months but I stopped when I saw a surge in the number of people with PML. But due to continuing to feel worse and worse despite my good efforts I decided to start on it again. I am wondering if having the infusion of Tysabri could present a problem with the contrast for the MRV on the next day. Any thoughts?


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Postby drsclafani » Sun Apr 04, 2010 3:39 pm

Can anything be read into the images of an MRV based on how "brightly" a vessels displays, in relation to other vessels?

For example, looking at my MRV, I see that a certain vein appears considerable more transparent than anything else in the image. It is like this in every image (the image is wide, so I have it as a link http://i81.photobucket.com/albums/j212/ ... nVeins.png)

And while I am here does anyone know what the exposure time is roughly on every frame? are we talking milliseconds or second


you are pointing to the arteries which contaminate this mrv. they are brighter because the have had less dilution than the contrast coming through the veins

dr z is correct :) which one tho?
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Postby CureOrBust » Sun Apr 04, 2010 6:07 pm

hmmm... :oops: yes... :oops: my radiologist responded and informed me that I had pointed to my "right subclavian artery, the brachiocephalic artery and the left subclavian artery", and NOT my veous system.... :oops: :oops: :oops:

Anyway, just to be clear, I am not looking for the final "diagnosis" from an MRV, I understand that the more complete findings will currently only be found while on the table with a catheter. I would just like to have some idea as to what to "expect" to be found, beforehand.
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Postby cheerleader » Sun Apr 04, 2010 10:08 pm

CureOrBust wrote:Anyway, just to be clear, I am not looking for the final "diagnosis" from an MRV, I understand that the more complete findings will currently only be found while on the table with a catheter. I would just like to have some idea as to what to "expect" to be found, beforehand.


Hey Cure- no answers from me, just wanted to say I'm proud of you for finally finding someone to test you and for following thru. I know it's been a long haul. Also surprised to see you mention being on a table with a catheter (knowing your aversion to said invasive treatments.) Jeff's MRV was pretty indicative (seeing his spaghetti collaterals and lack of jugs sealed the deal), but not everyone's is...really hard to know until the venography...but you already know that.
keep us posted, cure-
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Selective Venography or MRV

Postby MarkW » Mon Apr 05, 2010 2:22 am

Hello WeWillBeatMS,

I am not discounting MRV but sharing what experts are saying. Here is the reference please read it and share your conclusions:
csvi-ms.net/en/content/publications-venous-multiple-sclerosis#hojnacki10a

The author list and affliation is impressive:
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, and Zivadinov R
The Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA

The 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.

I am simply bringing the latest thinking to the chat room for people who do not have the inclination to plough through the scientific papers. Many people on the chat room will pay for this testing so best to get the most effective.

Kind regards,
MarkW
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 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
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Postby acol » Mon Apr 05, 2010 8:21 am

Hi Mark

Interesting theory!

I too am having some doubts about the value of MRV comparitive to a doppler test by an experienced operator. I have just returned from Poland having had both tests. To this day I don't know whether or not the MRV revealed any stenosis. This information was not given to me and I have been unable to find the answer by e-mail enquiry. However, what I do know is that Dr Simka detected problems within a few minutes by use of the much simpler doppler test - stenosis in both jugulars resulting in angioplasticy in rt vein and stent in the left.

I do have a CD Rom + photo of the MRV but to my untrained eye the test appears inconclusive. For all the time and trouble of the MRV I am unconvinced of its value. Furthermore, I found the MRV very uncomfortable for a range of reasons not the least being that it was painfully noisy.

At the back of my mind I wonder if the MRV may be more useful in detecting problems with the Asygous vein? I have been told that the doppler has limited value in some situations.

I think that it should also be borne in mind that some patients may have all sorts of difficulties using the MRV and therefore it would be reassuring to know that other tests, ie - the doppler, may be equally able to detect CCSVI.
Nigel
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Postby Johnson » Mon Apr 05, 2010 3:23 pm

Nigel,

I had the Doppler, and the Doc. said that according to Simka's training, I am a candidate for intervention. I still dropped another $1850 for the MRV, which I think was unnecessary, but there you go... The MRV report stated that no conclusion could be drawn regarding the azygous, because of "imaging limitations". The venogram is the gold standard, as we read here constantly. The Doppler ought to get you the venogram, IMHO.
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Postby acol » Mon Apr 05, 2010 3:37 pm

Johnson

As it happens the MRV was relatively cheap in Poland - much cheaper than in the UK or the USA. In any event it is now part of the package. I know that sometimes the problem cannot be identified with either the doppler or the MRV but will be picked up on the venogram - if the slight risk of an invasive procedure is thought justifiable without hard and fast evidence of either the doppler or MRV.
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Postby WeWillBeatMS » Wed Apr 07, 2010 9:04 pm

I'm going in for the MRV on Friday at noon. Wish me well.
<div>WeWillBeatMS<br /><br /><br />Zamboni for President!</div>
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