Dr. Haacke at ISNVD

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

Dr. Haacke at ISNVD

Postby Cece » Mon Feb 20, 2012 8:26 pm

Dr. Mark Haacke: CCSVI & Parkinson's 18 of 29 pts show same pattern as MS pts in brain iron & blood flow
Dr. Hacke now on Establishing MR Protocols. Iron is a biomarker for MS. It sounds like Dr. Haacke has a sore throat
Dr. Haacke: We have data on perfusion and flow. There's enough for neurologists to begin collaborating
Dr. Haacke: proof of concept with U/S difficult, but neuros use multiple scanning MS techniques w/out success all the time
Drs. Haacke, Sclafani, & Attariwala agree U/S is needed to detect intra luminal defects
Dr. Sclafani asked Dr. Haacke if MR can see valves. Dr. Haacke said only stuck valves can be seen inconsistently
Dr. Haacke: Total extra time needed to include CCSVI venous scanning during MR scan: six and a half minutes
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Re: Dr. Haacke at ISNVD

Postby Cece » Sat Feb 25, 2012 5:15 pm

from page 30 of the ISNVD abstracts http://www.isnvd.org/files/ISNVD%20Abstract%20Book.pdf
MRV Consensus (E. Mark Haacke, USA)

With the advent of CCSVI, there has been a major thrust to be able to non-invasively image vascular abnormalities in multiple sclerosis. Several groups are now doing MR imaging studies that include conventional anatomical imaging, vascular imaging, flow quantification, and iron imaging. The last three are over and above the usual anatomic imaging protocol requested by neurologists. There are several levels of these so-called CCSVI MRI protocols. Each uses a conventional neuroimaging protocol for MS with additional specialized sequences to study one or more of the vasculature in the brain, neck and spine as well as the iron content in the brain. On the vascular side, both anatomic and flow information is collected. A major benefit of using MRI is that it provides the neurologist with what he needs for assessing MS, it provides the interventionalist 3D planning and it provides all parties with critical flow information which may well become a key marker for deciding when or when not to treat a patient. MRI is also operator independent for the most part and the same protocols can be run on most manufacturers’ systems. These protocols should be designed to be viable on all manufacturer’s systems for 1.5T and higher field strengths. The data should be easily reproduced when run on the same equipment from site to site. Potential biomarkers for CCSVI and MS can be identified from this type of data acquisition. MRI can also longitudinally track the progress of the disease over time via lesion counts and type, physiologic changes like blood flow and cerebrospinal fluid (CSF) dynamics, and provide a baseline for future scans. This protocol should make it possible to collect data from different sites around the world so that it can be used in a collaborative research database to evaluate our knowledge of the role of the vascular system in multiple sclerosis. There are several versions of this CCSVI protocol, some being as short as roughly half an hour and others as long as one and a half hours. The more advanced protocols include imaging the brain, spine and azygous with the use of a contrast agent. Such protocols may also have different levels, the more research oriented including susceptibility weighted imaging and perfusion weighted imaging to monitor changes before and after treatment.
It's easier for me to see uses for MRV in research than in clinical practice. It gives some information that can be used to plan the treatment, but much of that can be garnered during the treatment itself with little added time to the treatment. Added time would mean added radiation. The question is if the added cost clinically of the MRV, which may be out-of-pocket from MS patients, is equal to the information it gives. The idea that the MRV gives information to both the neurologist and the IR implies a degree of working-together that we have not yet seen.
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