Venous drainage in MS - a combined MRI and ultrasound study

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

Venous drainage in MS - a combined MRI and ultrasound study

Postby MSUK » Sun Oct 30, 2011 11:53 pm

Image

ABSTRACT

Background: Chronic cerebrospinal venous insufficiency (CCSVI) was proposed as the causal trigger for developing multiple sclerosis (MS). However, current data are contradictory and a gold standard for venous flow assessment is missing.

Objective: To compare structural magnetic resonance venography (MRV) and dynamic extracranial color-coded duplex sonography (ECCS) in a cohort of patients with MS.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2944
MS-UK - http://www.ms-uk.org/
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Re: Venous drainage in MS - a combined MRI and ultrasound st

Postby CureIous » Mon Oct 31, 2011 12:04 am

Look ma! Another neuro imaging study!
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Re: Venous drainage in MS - a combined MRI and ultrasound st

Postby Cece » Mon Oct 31, 2011 8:04 am

ABSTRACT

Background: Chronic cerebrospinal venous insufficiency (CCSVI) was proposed as the causal trigger for developing multiple sclerosis (MS). However, current data are contradictory and a gold standard for venous flow assessment is missing.

Objective: To compare structural magnetic resonance venography (MRV) and dynamic extracranial color-coded duplex sonography (ECCS) in a cohort of patients with MS.

Methods: We enrolled 40 patients (44 ± 10 years). All underwent contrast-enhanced MRV for assessment of internal jugular vein (IJV) and azygos vein (AV) narrowing, graded into 3 groups: 0%–50%, 51%–80%, and >80%. ECCS analysis of blood flow direction, cross-sectional area (CSA), and blood volume flow (BVF) in both IJV and vertebral veins (VV) occurred in the supine and upright body position.

Results: MRV identified 1 AV narrowing. IJV analysis yielded 12 patients for group 1 (30%), 19 patients for group 2 (48%), and 9 patients for group 3 (22%). By ECCS criteria, 4 patients (10%) presented with venous drainage abnormalities. Jugular BVF was different only between groups 1 and 3 (616 ± 133 vs 381 ± 213 mL/min, p = 0.02). No other parameters in supine position and none of the parameters in the upright body position, apart from the IJV-BVF decrease in groups 1 and 3 (479 ± 172 vs 231 ± 144 mL/min, p = 0.01), were different.

Conclusions: Our ECCS data contradict the postulated 100% prevalence of CCSVI criteria in MS. MRV seems more sensitive to detect IJV narrowing compared to ECCS. A measurable hemodynamic effect only exists in vessel narrowings >80%. Our combined data argue against a causal relationship of venous narrowing and MS, favoring the rejection of the CCSVI hypothesis.

F. Doepp, MD, J.T. Würfel, MD, C.F. Pfueller, MD, J.M. Valdueza, MD, D. Petersen, MD, F. Paul, MD and S.J. Schreiber, MD

This is the full abstract. Dr. Doepp's team found CCSVI in the majority of MS patients using MRV. 70% of the patients had narrowings greater that 50% in their IJVs. He did not look at any healthy controls for comparison.

Using the doppler, a measureable hemodynamic effect was found when the narrowings are greater than 80%. I had two veins with that high grade of stenoses (80% in one, 99% in the other). He found 22% of pwMS had stenoses like this, greater than 80%, that had a measureable hemodynamic effect, which might be correctable through angioplasty.

He is looking at causation, which requires a very high degree of sensitivity and specificity (CCSVI is found in MS patients, it is not found in people without MS). We are not as interested in causation. Even smoking is not a cause of cancer, but a promoter of cancer. We are interested in CCSVI as a promoter of MS, as well as what happens to MS and to CCSVI symptoms when CCSVI is treated.
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Re: Venous drainage in MS - a combined MRI and ultrasound st

Postby MrSuccess » Mon Oct 31, 2011 10:11 pm

as far as I'm concerned .... any study of CCSVI that DOES NOT include the procedure of vein entry ......... cannot be measured against Dr.Zamboni's results and published papers.

The original 65 pwMS ..... CCSVI investigation and treatment ...... performed by the Zamboni TEAM .......... remains unchallenged.

As I have pointed out before ......... MRI's have about an accuracy rate of 95%. You can research this FACT if you wish. Or you can take my word ....and save some time.

The only way I know of that is 100 % ..... is insertion of a scope.

IVUS ..... looks to hold great promise.

The missing 5% ........ proves out important .... more than you know.

When Dr.Doepe includes FULL investigation of CCSVI ........... then I'll listen.



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Re: Venous drainage in MS - a combined MRI and ultrasound st

Postby Cece » Tue Nov 01, 2011 10:55 am

MrSuccess wrote:As I have pointed out before ......... MRI's have about an accuracy rate of 95%. You can research this FACT if you wish. Or you can take my word ....and save some time.

In Dr. Dake's study on the original summer of '09 patients, the MRV was compared to the venogram in the CCSVI patients, and it was accurate 80% of the time. This is higher than I'd have expected. It wasn't a Haacke protocol MRV so not attempting to look at flow, and much of the issues in CCSVI are intraluminal abnormalities, not structural. Structural abnormalities would show up on MRV better. I am not entirely sure that Dr. Dake could have diagnosed the CCSVI entirely accurately, either, because it was so early on, and he did find more up-high stenoses than other researchers seem to have found, and fewer azygous stenoses.
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Re: Venous drainage in MS - a combined MRI and ultrasound st

Postby scorpion » Tue Nov 01, 2011 11:56 am

MrSuccess wrote:as far as I'm concerned .... any study of CCSVI that DOES NOT include the procedure of vein entry ......... cannot be measured against Dr.Zamboni's results and published papers.

The original 65 pwMS ..... CCSVI investigation and treatment ...... performed by the Zamboni TEAM .......... remains unchallenged.

As I have pointed out before ......... MRI's have about an accuracy rate of 95%. You can research this FACT if you wish. Or you can take my word ....and save some time.

The only way I know of that is 100 % ..... is insertion of a scope.

IVUS ..... looks to hold great promise.

The missing 5% ........ proves out important .... more than you know.

When Dr.Doepe includes FULL investigation of CCSVI ........... then I'll listen.



Mr.Success



Didn't Dr. Zamboni use ultrasound as his measuring tool? Why would you want to use a completly different method of measument to compare to his study?
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Re: Venous drainage in MS - a combined MRI and ultrasound st

Postby MrSuccess » Tue Nov 01, 2011 1:28 pm

The ORIGINAL ZAMBONI 65 study of pwMS ..... included " non -invasive " diagnostic investigation ..... followed up with " INVASIVE " .... intervention treatment.

Not one or the other ..... but BOTH invasive and non-invasive procedures .

From this ........ Dr.Zamboni & TEAM ...... produced some very eye opening data on pwMS.

Our heros , Dr.Zamboni and his CCSVI team , presented to the world , his findings , and methods . And as expected from such an exceptional medical expert ..... an open invitation to any and all of his peers ...to validate and DUPLICATE his results.

The BNAC took up the challenge .... but only the non-invasive portion. As expected .. the results were mixed. No big surprise here. Read my posts [ and Cece's ] on the failure rate of MRI scans .

Bottom line : Until Dr.Doeppe - or any other doctor - completes a FULL pwMS >>> CCSVI .... study and/or trial .... that INCLUDES INVASIVE exploratory examination of the suspected faulty veins of pwMS .... their opinion is INFERIOR and holds no water.

Far better , to read the work of those brilliant medical professionals that HAVE duplicated and IMPROVED upon Dr.Zamboni's methods and results.

Scopion [ or Bob as I suspect ] you can open the morning paper and go straight to the comics ....... or go straight to the business section . It is obvious which path you choose.


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Postby Lyon » Tue Nov 01, 2011 4:18 pm

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Last edited by Lyon on Sun Nov 20, 2011 12:28 pm, edited 1 time in total.
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Re: Venous drainage in MS - a combined MRI and ultrasound st

Postby drsclafani » Tue Nov 01, 2011 10:09 pm

scorpion wrote:
MrSuccess wrote:as far as I'm concerned .... any study of CCSVI that DOES NOT include the procedure of vein entry ......... cannot be measured against Dr.Zamboni's results and published papers.

The original 65 pwMS ..... CCSVI investigation and treatment ...... performed by the Zamboni TEAM .......... remains unchallenged.

As I have pointed out before ......... MRI's have about an accuracy rate of 95%. You can research this FACT if you wish. Or you can take my word ....and save some time.

The only way I know of that is 100 % ..... is insertion of a scope.

IVUS ..... looks to hold great promise.

The missing 5% ........ proves out important .... more than you know.

When Dr.Doepe includes FULL investigation of CCSVI ........... then I'll listen.



Mr.Success



Didn't Dr. Zamboni use ultrasound as his measuring tool? Why would you want to use a completly different method of measument to compare to his study?


zamboni used US as his screening tool
and venography as his diagnostic tool

i agree, venography will show that most PwMS will have stenosis but many without MS will also. There are so many intraluminal problems, most but not all of which cause stenosis. Only IVUS and autopsy can show them very well.

scorpion, I assume which one you would choose when you are convinced by RCT that there is benefit to treatment :wink:
Salvatore JA Sclafani MD
Patient contact: ccsviliberation@gmail.com
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Re: Venous drainage in MS - a combined MRI and ultrasound st

Postby scorpion » Wed Nov 02, 2011 5:31 pm

scorpion, I assume which one you would choose when you are convinced by RCT that there is benefit to treatment :wink:


That may take quite awhile Dr. Scalfani for you see I have had MS long enough that I do not become overly excited about studies showing similar results to that of Zambonis. Generally you get the initial excitement (which includes stories of miraculous recoveries), the skepticism of mainstream scientists that is generally blamed on conspiracies, and of course a few die hard doctors that become the spokespeople of the "angry patients". Hopefully I am wrong because being cured would be very cool thing but unfortunately, up to this point, I can't say getting a balloon blown up in my neck is an avenue I am ready to explore.
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