Is an MRV or CT really enough?

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

Is an MRV or CT really enough?

Postby CureOrBust » Sun Aug 16, 2009 3:26 am

It really is a question. The wonderful Dr Dake has been performing MRV's (as well as dopplers and doing some poking about during the operation), however, reading Zamboni's papers, I read things that in my simple mind, may or may not show up on an MRV or a non-specific CT scan (by that I mean with no catheter injecting dye). I do not know.

From the paper presented at the Charing Cross conference:
Zamboni wrote:Histological examination of the involved veins reveals unequivocally the presence of characteristic signs of impaired venous drainage, such as perivenous iron deposits and fibrin cuffs, particular to chronic venous insufficiency.
OK, I don't know if these are actual abnormalities, or the results / tell tale signs of the abnormalities existing :? ahhh... you can bold the whole next quote...
Zamboni wrote:Most cases involved membranous obstructions of the junction with the superior vena cava, or, less frequently, twisting, septums and atresias as can be seen in the x-rays in figure 1.
Zamboni wrote:Membranous obstruction of the outlet of the azygous vein into the superior vena cava can be successfully managed by simple balloon dilation. This procedure was performed in 38 out of 77 cases, and no recurrence was recorded at 1 year.
PS: does anyone have a searchable version of this document? Bueller.... Bueller....
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Postby ErikaSlovakia » Sun Aug 16, 2009 3:41 am

I only know for sure, Dr. Simka told me and also wrote me I should go for a phlebography, it means with catheter+ injecting dye. His colleague asked him if MRV is not OK. He answered clearly no, phlebography is necessary.
Dr. Simka could not see everything with Doppler.
Erika
Aug. 7, 09 Doppler Ultras. in Poland, left Jugul. valve problem, RRMS since 1996, now SPMS,
- Nov.3,09: one stent in the left jug. vein in Katowice, Poland, LDN, never on DMDs
- Jan. 19, 11: control venography in Katowice - negative but I feel worse
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Postby Rokkit » Sun Aug 16, 2009 2:31 pm

I'm pretty sure Dr Dake told me on the phone he would be doing a venography right before putting the stents in just to make sure. Is a venography like a phlebography?

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Postby sou » Mon Aug 17, 2009 11:39 pm

Yes.

Vein = phleba (φλέβα in greek)

Venography is the latin name, phlebography the greek.

HTH,

sou
Shortest joke: "We may not be able to cure MS but we can manage its symptoms."
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Postby ErikaSlovakia » Tue Aug 18, 2009 12:01 am

Yes, this is what I know.
I put phlebography/venography, because some people are used to greek some to latin.
Aug. 7, 09 Doppler Ultras. in Poland, left Jugul. valve problem, RRMS since 1996, now SPMS,
- Nov.3,09: one stent in the left jug. vein in Katowice, Poland, LDN, never on DMDs
- Jan. 19, 11: control venography in Katowice - negative but I feel worse
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Postby mrhodes40 » Tue Aug 18, 2009 2:16 pm

Out of the operating room there are two ways to look and see. One is MRV and it uses gadolinium. It is operator dependant and subject to some variance because of that.

The CT Venography is where iodine is injected via IV into a vein and as you say it is kind of non specific.

IN THE OPERATING ROOM when they can place an intravenous catheter deep into the exact location where the occlusion is, they can inject a concentrated bit of iodine dye right where they want to look and then take a real time moving picture with a flouroscope which is in the OR. It is kind of like an x ray but it is in real time. These are the best, clearest pictures.

In Island Girl's case they did not see stenosis on MRV but did see an anomaly on the brachiocephalic. Dr Dake suggested they go ahead and do the venograms in the OR so he could get a really good look they could count on. They did so, then again reaffirmed the anomaly on the brachiocephalic but no obvious stenosis as had been seen in other MS patients.

SO the venogram is the gold standard, done in the OR with a fluoroscope --not a cat scan-- and iodine dye via a catheter that is deep in the vein.
I'm not offering medical advice, I am just a patient too! Talk to your doctor about what is best for you...
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