DSA - Digital Subtraction Angiography

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

DSA - Digital Subtraction Angiography

Postby sou » Wed May 06, 2009 12:18 am

Hi all.

I have spoken with the friend's friend vascular surgeon. He told me that MRV is very useful for azygs, IJV and VVs, but such a procedure could miss displaying some relatively small artifacts, leading to false negatives. Venography is much better a method and DSA is THE method.

In DSA, a catheter is inserted through the leg and is driven to the area of interest. An X-ray is performed before the dye is poured in the blood stream, and a second X-ray just after. Specialized software composes the 2 images, eradicating everything, but the dye. The result is a very clear picture of the veins, with astonishing detail level.

I think that I shall go to hospital for a week and have everything extensively tested.

sou
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Postby cheerleader » Wed May 06, 2009 5:21 am

Sounds like you have some good specialists helping you, sou. I know that Dr. Dake was able to see with more detail using the catheter/dye to insert the stents yesterday, but it didn't change Jeff's diagnosis, just how he chose to treat it.
MRV is a less-expensive, relatively benign way to check for most people,

Good luck, sou!
AC
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby mrhodes40 » Wed May 06, 2009 7:19 am

Sou how wonderful that you are going to add to the body of knowlege about this in this way, it sounds like your vascular guy is really on top of it. What great news that is!

I'm excited for all of us.
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Postby sou » Wed May 06, 2009 10:17 am

However, I am totally freaked out!

I can't relax. I have been thinking about many things. I could very well be the first MSer without vascular issues. In 16 hours I will know the results of the azygous scan.

My MS activity is very pronounced at the brain and the upper spinal cord, so the azygos could be normal. Or, it could be not...

I am going crazy! :-)

sou
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Postby cheerleader » Wed May 06, 2009 10:28 am

Sou...
Right now, your mind is creating alot of things that are not real. Try to stop thinking about "what if"...it does you no good!

Eckert Tolle (The Power of Now) writes and speaks about how most of our emotional pain is created in our minds by thoughts that are not real, or based in reality. There is nothing that these thoughts are doing, except making your body respond with adrenaline and cortisol. You will know more in the future. But right now, try to calm your thoughts.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby mrhodes40 » Wed May 06, 2009 1:42 pm

Sou,
you'll be OK information is power. You only have power if you have the right information. it's all good! :D
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Postby sou » Thu May 07, 2009 2:17 am

Hi.

MRV of the azygos system came up clear. However, I will have to double check with my vascular surgeon. IJVs and VVs were not displayed at all.

cheer:

It reminds me of Epicurus:

"Ταράσσειν ου τα πράγματα, μα τα περί των πραγμάτων δόγματα."

Translation: It 's not the facts that disturb the spirit, but what you believe about them.

sou
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Postby mrhodes40 » Thu May 07, 2009 5:32 am

You are reporting the actual radiology report of the test youhad tuesday, correct? So the radiologist how read the MRV agreed that it was, as you thought, clear? Are the jugulars being done today?
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Postby sou » Thu May 07, 2009 6:20 am

Hi Marie!

Yes, it is the report. The whole azygous system looks normal.

I feel a little worried that I could be the exception to the rule and have another variant of MS that does not require stenoses. But this is the voice of my depression and, perhaps, I shouldn't take it seriously.

The next thing I am doing is ultrasound to detect possible reflux at the region of my neck: IJVs and VVs. Perhaps a transcranial to detect reflux in the deep cerebral vein.

On May 18th I am meeting with my local vascular surgeon to do the paperwork. I will then go to Athens, at my friend's clinic, and have digital venografy, to depict ALL veins involved.

I only wish I find some stenosis.

sou
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Postby mrhodes40 » Thu May 07, 2009 7:22 am

I wish you well! A thorough exam is the best bet then work from what you learn there. That having been said though, I believe that if I were you that I would see Zamboni when it is possible if you do not get results that seem to make sense to you. It is clear it is possible especially with ultrasound doppler to have a study that is missing important information.

I was surprised when Dr Dake felt my dopplers were not as well done as should be and also when he said my right VV was bad too--the interpretation I got was the left had a mild reflux and everything else was clear.

Remember too Jeffs jugular stenoses were too high for doppler ultrasound to see as well. Dr Simka mentions this is a possibility in his paper also;
it should be stated that not all abnormalities, which are found in venographic
examination can also be visualized with sonography. For example, stenosis or occlusion in the
azygous vein cannot be directly diagnosed with ultrasounds, the same may apply to the
lesions localized in proximal parts of internal jugular veins.


It did not look like a difficult test, they put the transducer on my neck and the technician looked to see if it was blue or red, blue meaning it was flowing toward the heart, red flowing away. It looked very cut and dried and not at all difficult. Cure-or-bust mentioned that as well. We kind of came to the conclusion that a doppler was an easy test to do with certain and reliable results, but that is not apparently so. It seems there is some art and experience that plays in to interpretation of the results as my experience and Dr Simka's comments show.

Right now because this is so new and it has not been proven that all people with MS everywhere will have this, when there are people who do not fit and seem to have normal blood flow, the assumption is that the model is wrong; and that not all people with MS have CCSVI rather than assuming the tests are not well done or accurate.

But as more research goes forward there may come a day when if you have normal tests done by a skilled person and it shows no CCSVI they will look harder for the stenosis with better technology or you will be told it is not MS and they will loook for Hughes syndrome or gluten ataxia or frederichs or any of the other ataxic diseases.

That is going to be a very good day because everyone will get the right treatment .

While it seems possible that there are a couple of types of MS where some have ccsvi and others have something else, maybe autoimmune MS, it seems unlikely that Dr Zamboni managed to find ONLY the ccsvi ones when he tested nearly 900 people (including all studies and the Liberation 100 too).... and all the MSers-nearly 400 of them- had CCSVI when they unblinded the researchers. With the kinds of numbers the Ferrara team was dealing with he should have found at least a couple of people with typical clinically definite MS and the other pattern; the odds of him somehow by chance managing to see only CCSVI MSers are just too small unless the hypothetical "other pattern" is very rare.

Not to mention the Simka team has found CCSVI in all their MSers too...
I wish you well sou!
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