This Is MS Multiple Sclerosis Community: Knowledge & Support

Thanks for explaining the MRV flow quantification, Dr. Bart.
Jeff's MRVs did not include all of that--it was only upon venography that we saw the whole flow picture. I did not realize the Haacke protocol was able to quantify flow that specifically in all the major veins. I'm really looking forward to sitting down with the two docs and getting their insights next week. I'm interested in learning more about what they're seeing in oxygenation levels, perfusion and fMRI.
cheer

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Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
dual stents placed 5/09
CCSVI in MS

I had my MRV at BNAC. After having the procedure by Dr H in Baltimore I discovered that BNAC had found only 1 of my IJVs were stenosed. Dr H on the other had found that both my IJVs plus my azygous were malformed. I asked Dr Haacke about BNAC's imaging and he said that BNAC doesn't do any flow analysis and may be the reason why they are missing many IJV malformations. Of course BNAC also doesn't test for azygous problems either, nor does the Haacke protocol. It seems that venography is truly the gold standard to find any and all malformations. And of course finding and treating these malformations is also dependent on the experience of the particular IR. So it seems that any trial that just uses only doppler and/or MRV is just not really producing the proper data. Only venography can find these problems. How are we to believe the results of any trial, in Germany or anywhere for that matter, if no IR has actually looked at the subject with venography. This may mean that any of the trials funded by the MS societies could be suspect. It would be interesting to find out how many of the Hubbard patients had all their malformations detected with the Haacke protocol.

ozarkcanoer

I'm not sure what to make of this. CCSVI is a condition that makes for an unhealthy brain environment, in general. But so far CCSVI and MS have been closely linked. MS has the venocentric lesions that Parkinsons does not. Could this be a case of someone who had CCSVI that did not manifest in MS (but likely did have the fatigue and other CCSVI-symptoms)? And then it did somehow manifest in Parkinsons? Is it causal or coincidence? And yes - a big question would be if the treatment had an impact on the Parkinson's symptoms.

so there was the paper the other day from the chiropracter that suggests that 3 big neurogenrative diseases (MS,Parkinsons,alzheimers). are caused by ccsvi, and probably can be traced to the fact that we walk upright and other animals don't.

That would be bad news for mouse animal mosels.

Below is the flow quantification data from this previously mentioned movie.

http://www.youtube.com/watch?v=u-ry4Jjzvkc

I don't understand why positive and negative direction flows are graphed separately .. it feels like a kind of two-column accounting.

<shortened url>

You can see from the legend that they look at several arteries and veins. The graphs are for a single cardiac cycle. Arterial flow should only be up, and venous flow should only be down (in the neck, at least). So on page 5 you see some reflux in both IJVs. Bad bad bad, and it doesn't even have to be this bad for Hubbard to refer you to an IR.

Note also that the RIJV flows more than the LIJV, but that everything adds up in the end (page 7, again with the accounting). In the movie, the intensities of the vessel cross-sections vary with time, but aren't uniform - this says turbulence to me, and the measurements here indeed add up to reflux.

This all seems pretty definitive to me. Note that it doesn't say anything about the structure of the veins or valves. It's an operator-independent quantification of what's actually there.

It's not just the "Haacke protocol" that can detect reflux. The authors in this study
http://www.ncbi.nlm.nih.gov/pubmed/20695018
used MRI (MRV) to detect blood flow direction.

Yah, I'm just amazed MR can do it at all, and without contrast dye.

You may still need a special software or firmware package from the manufacturer in order to do FQ.

fMRI, for example, appears to be part of the Syngo software package for their MRI machines.

Thanks DrBart for the clarification. Dr Haskal. mentioned that the Hubbard MRV of my CCSVI companion, when I was treated, was spot on in finding the blockages he found on venography, as were Stanford's MRV, as well as Barrie Imaging doppler studies he saw in Canadian pwMS.

My 1.5T MRV with standard MRV protocol at local imaging place was worthless, say several IRs who have seen it. It found no stenosis, (tho it did show collaterals) and 1st venogram revealed severe stenosis, bilaterally.

CT scan is evidently least operator dependent and most revealing of the anatomical facts, however, also requiring a high radiation dose, which is unattractive.

Hubbard trained with Haacke and has a 3T machine, and then developed his own fMRI protocol based on his 25 years of research in fMRI. (and meditation)

So, while doppler is operator dependent, those operators who are properly trained, as the Barrie clinic folks are, can evidently do a darned good job,in a low cost, non-invasive manner, thanks to Dr Zamboni. that is a real gift to pwMS worldwide.

MRV should be done using 3T and Dr Hubbard's, Dr. Dake's, Dr Haacke's or similarly designed, protocols.

I hope each research institution competes for the best, most reliable technology. This is a battle, I can get behind as opposed to the one we seem forced to wage right now.

I'm wondering how well Doppler in Zamboni's hands would work on HH, whose IJV stenoses are directly under her clavicle.. as are a lot of folks', given that's where IJVs join the .. subclavian?

It should at least have revealed the reflux, but the actual narrowing is invisible to US.

shorter Zamboni: "Follow the flow"

Concerning the value of MR scans in CCSVI, Dr Haacke has new information on his CCSVI protocol here http://www.ms-mri.com/docs/ms-report-in ... mh-9pm.pdf This information is quite detailed and describes the report that is generated as a result of the Haacke CCSVI protocol. Among other things, the information shows how the MR scans measure blood flow, and concludes:

“Apart from the critical issue of acting as a treatment planning guide for the interventional radiologist or vascular surgeon, this information [the report that is generated as a result of the Haacke protocol] is the baseline from which you can judge what happens in the future. For example, do lesions go away, does blood flow improve, does iron content stay the same or reduce? Furthermore, if complications develop this baseline scan can help determine where the problem lies. All this is not possible if you do not have the initial scan run with the CCSVI protocol.”

Point #14 of Haacke’s FAQs discusses the pros and cons of CCSVI Doppler and MR imaging. http://www.ms-mri.com/faq.php

Hi drbart, are you a medical doctor?

Thx!

~HP

http://uprightdoctor.wordpress.com/

the guy keeps on coming up with interesting ideas.

No, I'm a CS PhD and amateur radiologist.

And I have one of the least HIPAA-compliant laptops in existence..

We have a one patient report that found CCSVI in a Parkinson's person.

It is NOT a confirmed diagnosis of CCSVI syndrome because there has been no selective venogram performed in the report. Selective venograms are required to show stenosis(es) of many veins. A researcher needs to check all major veins to start to document where any restrictions are found and the type of those restrictions.

WHEN such a report is made we will know that CCSVI syndrome occurs in Parkinson's patients NOT before. Science is a slow boring logical process and needs time for research.

Sorry for raining on the parade but someone needed to inject a dose of caution. Please slow down.

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