Doppler test

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

Doppler test

Postby Barry » Fri Aug 03, 2012 11:59 am

I'm booked for a Doppler test at Port Perry Imaging (in Ontario, Canada) in a couple of weeks. They use Zamboni's protocol and their
techs were trained by Dr. Sandy McDonald, or so they say.

Does anyone have first hand experience with this place? How did you find the experience?

What should I be asking or looking out for during this test?

Anyone in Ontario can get this test if they get a referral from their GP (or is that have a GP willing to give a referral).
Cost is $250.00 at this clinic.

I'm lucky to have a GP like I do. The reasoning I used with her is that it's my health and I'm in charge of it. How can I make
decisions while missing what might be an important piece of info.

Best of luck to all of you!
I run a fun little forum site – www.CanadiansTalk.net – check it out. You don't have to be
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Re: Doppler test

Postby Cece » Fri Aug 03, 2012 1:46 pm

I have no experience with the clinic (and hope that someone who does will post shortly) but I agree taking charge of our own health. Better to know if you have outflow obstructions or not before trying to make the next choice which is whether to go for treatment or not and the next choice which is where to go.

What should you be asking or looking out for during this test? I would say a Zamboni doppler should be fairly extensive so it can take up to an hour. The doppler may only be about 80% accurate, estimated, so if it comes back negative keep in mind that there are many people who had a negative doppler but had a positive venogram and were treatable.

Good luck and keep us posted!
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Re: Doppler test

Postby CureIous » Fri Aug 03, 2012 5:16 pm

Wish I had a bone to throw you, can say have recently had same type of doppler by Albany trained tech
and it showed both stented sides wide open, matching the MRV, I mean the band of blue was very large even my untrained eye could see. I could also tell she knew what she was doing by how the test was conducted, very minimal pressure, and yes, it took a good hour for the test.

Thats not saying much though, my first UT by untrained "non-Zamboni'd" tech showed the same thing, you can see on my vid it was anything but okay.

Get what you can get, how you can get it, we only have control over OUR knowledge, not theirs. So far in just my personal non-internet circle, I've had one MS death, and a handful more that couldn't get treated if they wanted due to $$ issues.

We are the fortunate ones, we at least have had, or do have some options. Many thousands of others have no options at all.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Re: Doppler test

Postby 1eye » Sun Aug 05, 2012 12:19 pm

Speaking of negative results, I heard of a woman (probably apocryphal) who called her child Negative Wasserman Jones. :smile:

What that has to do with CCSVI, or syphilis, I have no idea.
"Try - Just A Little Bit Harder" - Janis Joplin
CCSVI procedure Albany Aug 2010
'MS' is over - if you want it
Patients sans/without patience
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Re: Doppler test

Postby Barry » Fri Sep 14, 2012 9:27 am

I got the results from my doppler test. Some research is ahead to figure out
what the numbers mean. (if anything)

Supine Study
Right IJV cross section 95.0 mm²
Left IJV 127.0 mm²
No detectable flow in the vertebral veins
Normal antegrade flow in the internal jugular and deep cerebral veins.

Upright Study
Right IJV 4.1 mm²
Left IJV 20.2 mm²
Normal antegrade flow in the internal jugular and deep cerebral veins.

Critera for CCSVI 1/5 (qualifying factor for CCSVI is 2/5)

It seems the 'No detectable flow in the vertebral veins' is because it's either
hard to see or it may point to a problem in the azygos? Or maybe it's normal.
Time to do some reading.

I'm glad to have had the opportunity to get this test. Thanks Dr. Jen! It's just
not right that it's so difficult for us Canadians to get a referral for a $250 test
for what could be really important to know in managing our MS.
I run a fun little forum site – www.CanadiansTalk.net – check it out. You don't have to be
a Canuck. :)
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Re: Doppler test

Postby Cece » Fri Sep 14, 2012 11:04 am

There's research from Dr. Siskin on how those negative ultrasounds compare to what's found on actual venography
http://www.sirmeeting.org/index.cfm?do= ... s&abs=2088
The Diagnostic Utility of Ultrasound for Chronic Cerebrospinal Venous Insufficiency (CCSVI) in patients with Multiple Sclerosis

Authors:
J. G. Almond1, M. Englander1, K. Mandato1, S. Parikh1, G. Siskin1

Institutions:
1. Radiology, Albany Medical Center, Albany, NY, United States.

Purpose:
To evaluate the ability of ultrasound (US) to diagnose venous disease in patients with MS undergoing treatment for CCSVI.

Materials:
A retrospective analysis of all MS patients treated for CCSVI during an 8-month period was performed. The study population consisted of patients undergoing US of the internal jugular veins (IJV) within 24 hours of venography (CV). US was performed utilizing the protocol described by Zamboni, et al. A positive US met 2/5 criteria for CCSVI. A positive unilateral US met 2/4 criteria (without the transcranial evaluation of the deep cerebral veins). A positive CV was defined as one identifying a ≥50% stenosis in at least one vein, including the azygos vein. The US and CV findings were then compared.

Results:
416 patients were treated during the study period; the study population consisted of 310 patients (mean age 49 years; 30% male and 70% female). 224/310 patients (72%) had a positive US, and 155 (69%) of these patients had a positive CV; 86/310 patients (28%) had a negative US, and 66 (77%) of these patients had a positive CV (p=0.240). An ROC curve was generated (AUC=0.463). 300/310 (97%) patients underwent PTA of at least one vessel (215/224 with a positive US and 85/86 with a negative US) because venography showed either a ≥50% stenosis or a flow abnormality in association with a <50% stenosis; US therefore had a false negative rate of 99%. On the left side, 87/310 (28%) patients had a positive US, and 41 (47%) of these patients had a positive CV; 223/310 (72%) had a negative US, and 117 (52%) of these patients had a positive CV (p=0.472). On the right side, 63/310 (20%) patients had a positive US, and 28 (44%) of these patients had a positive CV; 247/310 (80%) had a negative US, and 130 (53%) of these patients had a positive CV (p=0.308).

Conclusions:
Findings on a Zamboni-protocol US are not associated with findings on contrast venography in light of the high false negative rate; 99% of the patients with a negative US had a significant stenosis and/or flow abnormality treated with angioplasty. A prospective study is needed to define the role of US and other modalities in the non-invasive diagnosis of CCSVI.

So if a patient has MS, they found that the patient has a 99% chance of having CCSVI found during venography even if he doesn't meet the criteria with the ultrasound. It's why Dr. Siskin's team stopped doing pre-procedure ultrasounds.

It sounds like your one abnormality criteria is no flow in the vertebral veins? Most IRs do not treat the vertebral veins. They are smaller than jugulars but can have malformed valves also. I don't know if this is an indirect sign of azygous blockage. The azygous can be looked at more directly via MRV or by venogram during the procedure itself. Not meant as medical advice.
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Re: Doppler test

Postby DougL » Fri Sep 14, 2012 11:19 am

sorry i missed this. my partner went to the toronto version of this clinic - June 2011. i was happy.

she too only had 1/5 but when we saw Dr S, he said 1/5 for sure and likely 2/5 or 3/5.

then he used IVUS - lets just say he saw the real picture of what was going on inside her.
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Re: Doppler test

Postby Barry » Sat Sep 15, 2012 7:03 am

Cece wrote:So if a patient has MS, they found that the patient has a 99% chance of having CCSVI found during venography even if he doesn't meet the criteria with the ultrasound. It's why Dr. Siskin's team stopped doing pre-procedure ultrasounds.

It sounds like your one abnormality criteria is no flow in the vertebral veins? Most IRs do not treat the vertebral veins. They are smaller than jugulars but can have malformed valves also. I don't know if this is an indirect sign of azygous blockage. The azygous can be looked at more directly via MRV or by venogram during the procedure itself. Not meant as medical advice.


Thanks for the info! I intend to look into venography / IVUS further. It never hurts to ask. :)
I run a fun little forum site – www.CanadiansTalk.net – check it out. You don't have to be
a Canuck. :)
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