Ultrasound study finds significantly more IJV abnormalities

[Cece]

Morphological and haemodynamic abnormalities in the jugular veins of patients with multiple sclerosis.

Radak D, Kolar J, Tanaskovic S, Sagic D, Antonic Z, Mitrasinovic A, Babic S, Nenezic D, Ilijevski N.
Source

Vascular Surgery Clinic, Dedinje Cardiovascular Institute, School of Medicine, Belgrade University, Heroja Milana Tepića 1 Street, Belgrade, Serbia.

Abstract
OBJECTIVES:
Multiple areas of stenosis and different levels of obstruction of internal jugular and azygous veins (a condition known as cronic cerebrospinal venous insufficiency) recently emerged as an additional theory to the well-known autoimmune concept, explaining etiology of multiple sclerosis (MS). The aim of our study was to evaluate internal jugular vein (IJV) morphology and haemodynamic characteristics in patients with MS and compare it with well-matched healthy individuals and to evaluate the prevalence of venous flow abnormalities in both groups.

METHODS:
Sixty-four patients with clinically proven MS and 37 healthy individuals were included in our study. In all patients, IJV morphology and haemodynamic characteristics were evaluated by colour Doppler sonography as well as venous flow disorder. The patients were classified into four groups according to MS clinical form presentation. The prevalence of morphological and haemodynamic abnormalities in the IJV were assessed.

RESULTS:
The presence of stenosing lesion, mostly intraluminal defects like abnormal IJV valves, were observed in 28 patients (43%) in the MS group, and in 17 patients (45.9%) in the control group (P = NS). By adding haemodynamic Doppler information in the IJV venous outflow was significantly different in 42% of MS patients showing flow abnormalities (27/64), as compared with 8.1% of the controls (3/37), P < 0.001.

CONCLUSION:
In our group of patients, patients suffering from MS had significantly more IJV morphological changes and haemodynamic abnormalities when compared with healthy individuals not suffering from MS. These findings can be well demonstrated by non-invasive and cost-effective Doppler ultrasound.

http://www.ncbi.nlm.nih.gov/pubmed/21903685

Lesions were equally present in both groups but in the MS patients the hemodynamics were significantly different.

This is interesting in relation to what Marie recently posted, in her "E. Hutton" post, that one of the debates in CCSVI is if you treat the structural abnormality or if you treat the abnormal flow. She explained it better than that though. This study found structural abnormalities equally in both MS patients and healthy patients but flow abnormalities much more commonly in the MS patients.

[1eye]

Is it a coincidence that this kind of result appears in Belgrade, and not in Canada?

[HappyPoet]

Cece, what you said about Marie's post goes back to what Dr. Zamboni has said about CCSVI--it's all about the flow. But... how would an IR treat for one and not the other? How exactly would the two procedures be accomplished differently, or should this question be: Does a structural problem present differently than a flow problem, and if yes, how are the differences identified? I would think that if you treat valves that are stuck closed, the flow would automatically be improved? But that doesn't seem to be the case?

1eye... I enjoy your humor and hope Canada's time comes soon.

[Cece]

I think this is suggesting that you can have blocked valves (perhaps low grade instead of high grade, so there's a lesser degree of stenosis) that don't disrupt flow, found in healthy volunteers, and blocked valves that disrupt flow, found in MS patients.

It seems logical that flow does not disrupt itself but there is something disrupting the flow. In addition to intraluminal abnormalities (valves, membranes, etc), there could be external physiological compressions.

It's only one study, I don't think we can read too much into the findings.

Has Canada finished any studies yet? As far as I was aware, the decision to go forward with clinical trials was in part due to unreleased positive results from some of the Canadian imaging studies underway. Dr. MacDonald in Canada was able to clinically find some CCSVI, at least in his first five patients before the rug got yanked out from under him.

[1eye]

Like I said in the other thread, you only have to disrupt the flow to parts of the brain that control the flow elsewhere, to disrupt the flow somewhere completely remote from the initial disruption. It's a chain of control with a single point of failure for multiple vessels.

[HappyPoet]

Thanks Cece and 1eye, I think I understand better now. The part about a change in one part of a system (the control center) affecting another part of the system far away makes sense, if I got that part right, that is.