Flow & anatomical abnormalities in MS vs Controls using MRI

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

Flow & anatomical abnormalities in MS vs Controls using MRI

Postby brocktoon » Wed Oct 15, 2014 11:46 am

Hello everyone,

I am delighted to present this work fresh off the presses. Within the paper lies clear differences in venous anatomy in the MS and HC samples, but most importantly in jugular flow between the two. Also elucidated are the pitfalls of the Rodger and Traboulsee studies. Specifically, using individual IJV flow and percent stenosis method, instead of total IJV (and normalized IJV flow to arterial flow) and using fixed area for determining stenosis.

Some of you are privy to this already if you were at ISNVD or at the NCS conference in Sherbrooke. I welcome any criticisms you may have as well.

Link

http://onlinelibrary.wiley.com/doi/10.1 ... 3/abstract

& PDF (note: will eventually be free to public from PubMed)

http://onlinelibrary.wiley.com/doi/10.1 ... .12183/pdf
http://www.ncbi.nlm.nih.gov/pubmed/25316522
Last edited by brocktoon on Thu Oct 16, 2014 10:21 pm, edited 1 time in total.
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby 1eye » Thu Oct 16, 2014 7:22 am

Hello brocktoon!

Thank you for all your hard work. To me, you and Dr. Haacke deserve a Nobel prize for this.

It is pretty futile to try to argue with your conclusions. It will be tried, in editorial comments in journals, in the press, and elsewhere. But really, all that's left is for somebody to verify your results any which way they can.

That is a signal piece of scientific thinking, normalizing to arterial blood flow. That was the stroke of genius that broke this controversy wide open.

In my own words: when you compare jugular blood flow to a norm established by using the same group of patients' arterial blood flow (which should be the same), "MS" patients with CCSVI have a lower jugular flow.

What it does to a person to have venous blood flow rerouted through spinal and collateral veins has yet to be determined. It may be that blood flow overall is less than it would be without the stenosis. It may be that certain parts of the brain which require the higher blood flow of open jugulars, have less efficient waste removal.

One thing is clear from your work. People with these stenoses and whatever other problems they may bring, are more likely (much more likely) to have been diagnosed with "MS". Whatever that might mean, and I think many of us here are familiar with it. Regardless of what it means medically (many, many different things to different people). Regardless of what may be causing stenoses in jugulars.

Making these stenotic jugulars work better is necessary, and perhaps the very first treatment most "MS" patients should receive. It is a disease-modifying treatment of the very first order.

If they want the financial benefits of people going back to work, clear, perhaps permanently, of the symptoms caused by jugular inefficiency, they had best start paying for these treatments. Now. The treatment might still be anachronistically called experimental. Those perhaps more visionary in the insurance business will know that the earlier this is treated, the more they stand to gain.

Your work corroborates and verifies the work of Dr. Paulo Zamboni in an in-controvertible way. Shouting can begin any time.
Last edited by 1eye on Thu Oct 16, 2014 8:34 am, edited 4 times in total.
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby 1eye » Thu Oct 16, 2014 7:40 am

ABSTRACT
BACKGROUND

To determine if extracranial venous structural and flow abnormalities exist in patients with multiple sclerosis (MS).
METHODS

Magnetic resonance imaging was used to assess the anatomy and function of major veins in the neck in 138 MS patients and 67 healthy controls (HC). Time-of-flight MR angiography (MRA) was used to assess stenosis while 2-dimensional phase-contrast flow quantification was used to assess flow at the C2/C3 and C5/C6 levels. Venous flow was normalized to the total arterial flow. The MS patients were divided into stenotic (ST) and nonstenotic (NST) groups based on MRA assessment, and each group was compared to the HC group in anatomy and flow.
RESULTS

The MS group showed lower normalized internal jugular vein (IJV) blood flow (tIJV/tA) than the HC group (P < .001). In the MS group, 72 (52%) were classified as ST while 66 (48%) were NST. In the HC group, 11 (23%) were ST while 37 (77%) were NST. The ST-MS group had lower IJV flow than both HC and NST-MS groups.
CONCLUSION

After categorizing the MS population into two groups based upon anatomical stenosis, as determined from an absolute quantification of IJV cross section, clear differences in IJV flow between the ST-MS and HC samples became evident. Despite the unknown etiology of MS, abnormal venous flow was noted in a distinct group of MS patients compared to HC.
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby Cece » Thu Oct 16, 2014 9:00 am

Congrats on what appears to be well-thought-out successful research.

There has been a great deal of conflicting ccsvi research based on noninvasive doppler studies so if MRA is a superior imaging method because it can be standardized, then that would be a step forward.
Also elucidated are the pitfalls of the Rodger and Traboulsee studies. Specifically, using individual IJV flow and percent stenosis method, instead of total IJV (and normalized IJV flow to arterial flow) and using fixed area for determining stenosis.

Has there been any cooperative response from Rodger or Traboulsee or interest in reanalyzing their data with this method?
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby brocktoon » Thu Oct 16, 2014 9:31 am

That is a signal piece of scientific thinking, normalizing to arterial blood flow. That was the stroke of genius that broke this controversy wide open.

In my own words: when you compare jugular blood flow to a norm established by using the same group of patients' arterial blood flow (which should be the same), "MS" patients with CCSVI have a lower jugular flow.


Precisely, and though we may have some normals with stenosis and low flow, what their symptoms in 10-20 years should be investigated, but it is too soon to tell.

The normalization is critical and helps account for the physiological differences in people indirectly (age, mass, gender etc). In the workings are a few papers with added normals and about 450 more MS cases, we noted similar arterial flow between all groups, ms-subtypes, and stenosis classification. To come, is categorizing and quantifying venous collateral flow, we have already noted the clear differences in paraspinal venous flow in the MS sample. Not surprisingly that collateral flow type is inflated. Also, we want to normalize arterial flow to the brain volumes which will show that similar arterial flow in large vessels between groups is not a confounding factor.

Thank you again for your kind words, it means a lot.
Last edited by brocktoon on Thu Oct 16, 2014 8:18 pm, edited 1 time in total.
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby brocktoon » Thu Oct 16, 2014 9:33 am

"Has there been any cooperative response from Rodger or Traboulsee or interest in reanalyzing their data with this method?"


Not to my knowledge, but the gauntlet has been thrown!
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby 1eye » Thu Oct 16, 2014 11:24 am

Can anybody get this link http://www.thisisms.com/forum/chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic25432.html to Anne Kingston? I think she might want to know.
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby brocktoon » Thu Oct 16, 2014 11:54 am

Can anybody get this link chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic25432.html to Anne Kingston? I think she might want to know.


I will forward to her, I spoke with her at Sherbrooke about this when it was only a talk at the time.
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby cheerleader » Fri Oct 17, 2014 6:19 am

Fantastic work from the team, brocktoon! Was exciting to hear you present in Sherbrooke and speak at ISNVD in Feb.--- and great to see this research finally published! You guys are incredible brainiacs---and good people, too.

As an FYI to 1eye's comment about "certain parts of the brain" that might be impacted by this insufficient venous return--the thalamus is turning out to be the area of interest of MS neurologists--they note thalamic atrophy and iron deposition in this critical brain region for those with MS.
http://www.ncbi.nlm.nih.gov/pubmed/23613615
http://www.ncbi.nlm.nih.gov/pubmed/17875909
http://www.ncbi.nlm.nih.gov/pubmed/24819917

In fact, some researchers are now looking at how "novel" MS drugs address this loss of brain tissue, and getting research funding!
http://www.buffalo.edu/news/releases/2013/03/028.html

I think one place to look might be at how insufficiency of the deep cerebral veins and a widened third ventricle, due to altered venous hemodynamics, is impacting this region.
http://www.upright-health.com/thalamus.html

I asked Dr. Zivadinov at ISNVD why he was looking at the thalamus for his drug research, but not for CCSVI investigations. Didn't get an answer. Maybe you can find out why!

Here's hoping,
cheer/Joan
(PS--Jeff's thalamus and third ventricle now look perfectly normal on MRI. Going on 6 years since venous repair at Stanford.)
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
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Re: Flow & anatomical abnormalities in MS vs Controls using

Postby 1eye » Fri Oct 17, 2014 6:51 am

This might seem off-the-wall, but...

I was prompted by a notice about the upcoming ECTRI"MS", and I thought I'd share.

You see, they are doing work on parasitic infections apparently. I can not do any investigating myself, but I have been wondering since reading Dr. Schelling's paper, about one thing: the size of the Dawson's fingers. They are not microscopic at all. I think he even calls them macroscopic. They seem to extend outward from the ventricle.

I have been wondering since watching "House MD" #1: what if they were right? Specifically, we seem to have unexplained modifications from the normal size and shape of our veins. These would seem to favor something which hangs around slow-moving blood. Plus if there's one thing parasites really like, it's a blood meal. What if the reason for stenosis, webs, septa, etc., were a parasitic organism which has evolved a way to slow blood down even more than normal physiology does, by attacking veins and making them morph in reaction?

Even better than that, what if the key to treating "MS" were a simple pill, that works right away, and you don't have to take any more? Like in "House MD"#1?

Just wondering about those "anatomical abnormalities".
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