Test your MRV reading knowledge

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

Test your MRV reading knowledge

Postby Nunzio » Tue Apr 27, 2010 1:27 pm

Image
This is a recent MRV I had done.
Please tell me which side you think has a problem.
Hint: I have CCSVI.
I will post the radiologist reading later, but he was partially wrong.
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Postby Johnson » Tue Apr 27, 2010 2:34 pm

That right IJV looks to have lost it's way to the b-c plexus. It is hard to see much from just one pic, but sheesh...
My name is not really Johnson. MSed up since 1993
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what's the skinny?

Postby hwebb » Tue Apr 27, 2010 5:21 pm

I reckon the right side (skinny side) looks a bit scary too. But you wont know for sure where the problem/s lie until you get a venogram.
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Postby ndwannabe » Tue Apr 27, 2010 5:45 pm

Another thing I am thinking is this - even though the doctors say the different diameter in jugulars is "normal", I think one gets bigger than the other for a reason.

And I would theorize that the reason is a blockage of some sort in the skinny one.

To me it would look like the left jugular is "taking over".

Another possibility could be that it is a lest one that has a blockage way down low and was stretched out by undue pressure of the blood trying to make it's way to the destination (is it vena cava, the "destination" that is?)
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Postby Nunzio » Wed Apr 28, 2010 3:53 am

This is the official reading from the radiologist:

MR venogram-

3-D TOF and 2-D TOF SPGR imaging was obtained.

The sagittal sinus is patent. The sagittal sinus is normal. The left
transverse sinuses patent. The left sigmoid sinus is patent. The
internal jugular vein is patent.

There is severe attenuation of the more distal aspect of the right
transverse sinus with proximal occlusion consistent with
recanalization and reconstitution of a thrombosed proximal right
transverse sinus. The sigmoid sinus is atrophic with flow into an
atretic internal jugular vein.

Great vein of Galen is patent.

Dural branches are patent.

IMPRESSION-
1. Patent sagittal and left transverse sinus with normal sigmoid sinus
and normal left internal jugular vein.
2. Occlusion of the proximal right transverse sinus with
reconstitution of an atretic right transverse sinus, sigmoid sinus and
internal jugular vein.
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Postby Nunzio » Wed Apr 28, 2010 4:33 pm

OK; so everybody got it right, but the price goes to Wannabe.
What the radiologist called normal left jugular vein in reality has a stenosed valve at the junction with the brachiocephalic vein (very low on the picture)
This was evident using Color Doppler which showed extensive reflux and no change in diameter between vertical and horizontal position.
The reason for this post is to show that MRI is a static test and can easily miss
a blocked vein.
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Postby ndwannabe » Wed Apr 28, 2010 6:38 pm

Nunzio wrote:OK; so everybody got it right, but the price goes to Wannabe.
What the radiologist called normal left jugular vein in reality has a stenosed valve at the junction with the brachiocephalic vein (very low on the picture)
This was evident using Color Doppler which showed extensive reflux and no change in diameter between vertical and horizontal position.
The reason for this post is to show that MRI is a static test and can easily miss
a blocked vein.


Thanks for the update! This is how we all learn here. What's your plan Nunzio?

(And of course, I am glad I got the prize, even though I typed "lest" instead of "left" :lol: )
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Postby Nunzio » Thu Apr 29, 2010 2:47 pm

I am going local and my vascular surgeon is involved with this; he is excellent and he is in contact with Dr. Dake who has a lot of experience to see what to do next.
I am hoping in a venogram/angioplasty soon.
I will keep everybody informed.
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