This Is MS Multiple Sclerosis Community: Knowledge & Support

Not exactly: http://www.thisisms.com/ftopic-14402-20.html

sarcasm is not a useful contribution to the discussion, remember we're together in this, not fighting each other, please and thank you.

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Yes, you'r right Sotiris, sry, but in a wood of Ug-Jug contests and 500-2000 liberated MS-ers I was anable to find a tree (study link you provided). Unfortunately, that thread about study was already ended miserably, so I started a new thread. Subject is too serious to burry it without considering. Best regards, M.

I know this post was done slightly tongue-in-cheek, but it raises a valid point that was succinctly stated by Cheer in the other thread.



So we have Munzio's, Jeff's, Johnson's and my MRV's each showing much more severe stenoses associated with our positive diagnosis of MS. 4 for 4. I wish others who have had MRV's would chime in because this is strange.

Here is a link to the forbidden thread where you can view comparative MRV's.

http://www.thisisms.com/ftopict-14402.html

..

The study suggests that half the MS patients did not demonstrate a stenosis. This is why I am asking for others to comment on their MRV results. Presumably, if the study is valid, half the MS patients going in for MRV's should come out with negative findings.

The other point to this is none of the images displayed in the study appear to show significant stenoses at all - in the MS patients or in the controls. This is the anomaly of which I speak. Look for yourself and see if you disagree. I wasn't trying to link stenosis severity with disease severity.

Haacke better step up to the plate and comment on this because his data set should be much larger on MS patients. I am sure he must have also looked at healthy controls.

I don't think the proper response to this study, however, is to retreat further into the veins by saying it's not a venogram or to jump back into the DU box.

If I remember Cheer's husband had very severe stenosis yet had fairly mild MS sympotms. Does anyone find it ironic that pics are posted on this forum and the stenosis is "obvious" yet none of us were trained using Zamboni's STRICT standards? Maybe there is not stenosis in the veins that are posted as "gimmees" but instead they are "normal" for that particular person. Of course since the definition of normal veins have not been established it makes my question rather pointless.

RESULTS MRV:

And this is how they acquire data/images:

And this is how they analyse images:


Thats give a better picture about how complex analysis are made and that pictures/examples in the study material are just informative 2D pictures. There is a whole bunch of MRI pictures analysed in 3D for resulting conclusions - not shown here.

From a study discussion:


Munzio's, Jeff's, Johnson's and Jugular's MRV's each are showing just a snapshot. No hemodynamic at all. Pictures don't represent veins - they represent dye flow inside the some of the veins. And that's not the same - at all.

In contrary, diagrams on
Figure 8 "Examples of quantitative venous blood flow analysis in the straight sinus (top row) and internal cerebral veins (middle and bottom row) of healthy controls (HCs) and multiple sclerosis (MS) patients who were classified as having a normal (left columns), possibly anomalous (middle columns) and probably anomalous (right columns) venous outflow anatomy. No venous backflow/reflux could be observed in any MS patient or HC."
are dynamic, they measure blood flow in ml/s versus time in msec.

That's much better approach then a ECD and TCCS methods, which are strongly operator-dependent, and intracranial venous blood flow is difficult to measure. In contrast, magnetic resonance venography (MRV) is a non-invasive, sensitive, operator-independent technique for the evaluation of venous anatomy and pathological changes, and is widely used in the clinical setting.

The MRV images are pretty standard front view images showing the veins as the contrast dye goes through them. While you only see one image depicted there is actually a slideshow to view as you can spin around the view point and look at the same stenoses from front and the side. There are more than one image taken and in the ones presented in the report a few are laced together. The stenoses don't play a game of now you see them now you don't

The point I makes about the images used to illustrate the study's findings is thar they all depict a mild stenosis or minor malformation. If these images are typical, and one required a moderate to severe stenosis to qualify, then none of the patients in the study would fit the bill. Certainly, though a venogram looking at all the involved veins might find different, it would be questionable whether these patients would bother with repair.

So I don't know what gives with this study. I really hope Haacke comments about it because he probably has seen hundreds upon hundreds of MRV's fed to him several imaging centers. If this study is true, half of those images would show no stenoses. He would also be able to comment upon what is typical and whether he's looked at 'normal' patients.

Until then I am going to throw it out there that the type of moderate to severe stenoses and malformation seen in our cases are not normal and are far more likely to be found in MS patients.

Has for the blood flow part you are absolutely right - the images are only part of the 'picture'. In my case (I am not sure about the rest) Haacke's report came with detailed blood flow analysis, complete with charts and tables. The difference between his approach and the Dutch study is that the Dutch study measured flow at one point in the cerebral veins, whereas Haacke measures at two locations, the upper and lower neck.

Perhaps the Dutch researchers believe that flow analysis is more relevant upstream than downstream. I would say that the differences are more patent downstream. The other point is that the Haacke analysis shows if the left and right flow is asynchronous and whether the flow from the jugulars is diverted. To me, having these main exhaust pipes to the brain open and flowing well is what's behind the improvements seen in patients undergoing venoplasty.

Edit: I am pasting a link to a Haacke report from the False Creek site, so you can see for yourself the differences in methodology in flow analysis (as well as another image of a patent stenosis or malformation)

http://www.falsecreekhealthcare.com/sha ... n-2010.pdf

This is the advantage of an MRV v. DU. As Maiden says, the images are operator independent. A disadvantage is that the images can only be taken when the patient is lying down and in a fixed position. With DU, readings can be taken while the patient is in a variety of positions. For instance it can determine whether the IJV's open and close normall when the patient is upright and lying down. The other advantage is that it is much cheaper and more easily tolerated than being bolted on a board and stuck in a noisy tube for a few hours.

Yes, I totaly agree with you. Lets look at, for example, those two pictures:



(If author has complains about posting this pics, I'will remove them emmediately).

The locations marked as: "Tin Whistle Stenosis" and "?" on the first picture looks normal (without stenosis) on the second picture. Vessel is the same, location is the same, but point of view is about 45 deg. rotated (PL-AR first pic, L-R second pic.)

Is this a real stenosis? Or just a flat twisted vein hose in two different views?
As you said: "The stenoses don't play a game of now you see them now you don't."

Best regards, M.

I'm not sure that we can completely do away with experts in reading MRV images and I am not sure that Johnson would want us to be debating about his veins, but I think he will allow that those are arrows that he drew on his own MRV image.

The specialist reading the images will look at them all not just the frontal view. They also will know more about what is a collateral or not. I was able to see the stenosis in my images before getting Haacke's report, but the report showed so much more and was illustrated with arrows just like the sample report I linked.

I remember the moment of revelation going through my own images. I clicked on a file called "neck MRV". It didn't show anything that I could see until I realized it was a side view and the start of a series of images. It was only after I clicked on "play" did I see my jugulars spinning into view. I could see the severe stenosis in the right that stayed being a stenosis no matter the angle.

I think that Johnson will know more about his own images and any reports that he received, but (with apologies to Johnson) they do look much more messed up than the Dutch ones.

I was more interested in your comments on the different protocols used for blood flow analysis in the Dutch study and the sample we have from Haacke.

Edit to add: one thing that didn't know what I was looking at until I received the Haacke report is that it also has a top-down cross-sectional views of the jugulars at various levels (slices). These are also used in conjunction with the other images to detect a stenosis. They can run, but they can't hide.

They both use same machine, GE 3.0 Tesla MRI system:

and the phase-contrast flow quantification with the same velocity encoding: 50 cm/s.

Woa woa woa.. completely aside from the point of your post, I think this MRV is really interesting.

The Haacke contrast-enhanced images don't extend to the back of the head, but yours does ... and what looks like a pinch in your left transverse sinus looks really really interesting.

Can you export a 360-degree movie of this, perhaps with a tilt so we can see the transverse sinus veins more clearly?