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Hey there,

Found this article that discusses a non-invasive measurement of blood flow through the Azygous Vein.

Quote:

J Hepatol. 1995 Apr;22(4):399-403.
Non-invasive measurement of azygos venous blood flow using magnetic resonance.

Lomas DJ, Hayball MP, Jones DP, Sims C, Allison ME, Alexander GJ.

Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
Abstract

Monitoring treatment efficacy in patients with portal venous hypertension has been limited by the difficulty of direct or indirect assessment of portal vein pressure. The majority of currently available haemodynamic tests, such as hepatic vein wedge pressure or azygos vein flow measurement by thermodilution catheter, are invasive which has restricted their application. We describe a non-invasive cine phase contrast magnetic resonance technique for quantitative measurements of bulk volume flow and for demonstrating flow changes during the cardiac cycle in the azygos vein. The technique was used to analyse the azygos vein flow in seven adult volunteers and five patients with biopsy-confirmed chronic liver disease, portal hypertension and endoscopically proven oesophageal varices. In the volunteers the mean volume flow rates varied between 81 and 241 ml/min with a mean for the group of 171 ml/min. The patients had a significantly higher mean volume flow rate of 628 ml/min (p < 0.01), with a range of 339 to 945 ml/min. These preliminary results suggest that cine phase contrast magnetic resonance angiography is a practical non-invasive method for measuring absolute azygos vein flow, and may provide a non-invasive method of monitoring portal hypertension.
http://www.ncbi.nlm.nih.gov/pubmed/7665858

Could this be a way of diagnosing/screening the Azygous vein without doing a Venogram? Thoughts?

LR1234 wrote:I had a CT scan (and an MRV) but CT uses radiation and at quite high doses I think.

drsclafani wrote: I fully empathize with patients who fear progression and want this immediately. If I were an 'MSer I would be looking for someone to treat me. However as trials get up and going, patients have some responsiblity to participate in these. Just as Zamboni's patients chose to participate, not only for their own benefit but for that of all MSers, so too should you join those trial to prove the points about which you feel so passionate .

L wrote:Hello Dr Sclafani

I'm on your list, perhaps things will be a bit tricky though as MRV is contraindicated with me (unless it is less powerful than MRI) because of the inch long end of a defibrillator wire in my heart. The defibrillator itself was explanted as it was quite unnecessary, placed there by an over zealous cardiologist.

Apparently, according to Dr Halperin at Johns Hopkins who has conducted a study on the subject of MRI and pacemakers/defibrillators, and who kindly responded to my enquiries and the x ray of me that I sent him, told me that such a short lead would heat far more than the whole defibrillator intact and would not allow for an MRI scan.

So my question now is, aside from the strength of an MRI being the same as an MRV or not, A doppler scan, although not as useful as an MRV, is still very helpful in many cases, no?

Thanks!

fogdweller wrote:It may be burried somewhere in the previous 89 pages, but how do I get on Dr. S's waiting list??

I think I am on a list at Stanford, but would like to get on as many lists as possible since I may be ineligable for some studies , and get in others only after a very long time.

nancymno wrote:Dr. Sclafani - This is the first time I have posted. I have been following your thread since early April when I also contacted Holly to be put on your waiting list. Because my disability score has moved approximately 2 - 3 points (that would be upward) in the last 2 years and I am nearing or at a 6, I feel I don't have the time to get through waiting lists. By the time you or someone else get to me, I could be at 8.5 and ineligible. You are 700 miles from my home and it occurred to me I have never tried contacting an interventional radiologist in my own community. I gave it a shot and I have an appointment for a consultation next week. I am told by his nurse he has performed many balloon therapies on the jugular veins and stenting if necessary for other reasons. If he should be agreeable to doing this procedure (probably a big if), what does he need to know that might be different regarding an MS patient? Should I even take a chance on letting him do the procedure? (I have read your posts and have grown quite comfortable with the knowledge you have attained in this area. You have done several procedures and seem to have gained more and more expertise as you have done them). Is there anything special he needs to know about performing the procedure as it relates to MS? It could be he will not be receptive to the whole idea and I will remain on your waiting list, but I would like to be prepared.

JCB wrote:Dr. Sclafani,

I was diagnosed with Diabetes Mellitus in 1982, no renal malfunction to date. I currently have MRI's w/ contrasting agent. Would this still put me in the Contraindicated category?

PPMS 11/07

fogdweller wrote:

drsclafani wrote: I fully empathize with patients who fear progression and want this immediately. If I were an 'MSer I would be looking for someone to treat me. However as trials get up and going, patients have some responsiblity to participate in these. Just as Zamboni's patients chose to participate, not only for their own benefit but for that of all MSers, so too should you join those trial to prove the points about which you feel so passionate .

I agree, in principle, and have participated in trials in the past, even ones I was pretty sure would not work. I even finished up a three year study that was having some negative effects on me when I knew that it was not helping in order to help have clean data for the study.

However, I am 57, have been diagnosed for 35 years, and the last 5 years have begun progressing more rapidly. I have PPMS, not RRMS, so no drug helps at all. Because of these factors I likely will not meet the inclusiion criteria for a trial, so I am not sure it makes much sense or helps fulfill a duty to stand in line to try to get in a trial that that probably won't take me, probably will take 2-3 years to complete, and will probably take 2-3 years before any data is analyzed and available.

I agree we are an army and hope to help but waiting for treatment may not make sense.

hwebb wrote:Dr S,

fellow TIMS participant "ikulo" found this interesting paper. Just recreating the reference in your thread, as you may have thoughts on it:

Hey there,

Found this article that discusses a non-invasive measurement of blood flow through the Azygous Vein.

Quote:

J Hepatol. 1995 Apr;22(4):399-403.
Non-invasive measurement of azygos venous blood flow using magnetic resonance.

Lomas DJ, Hayball MP, Jones DP, Sims C, Allison ME, Alexander GJ.

Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
Abstract

Monitoring treatment efficacy in patients with portal venous hypertension has been limited by the difficulty of direct or indirect assessment of portal vein pressure. The majority of currently available haemodynamic tests, such as hepatic vein wedge pressure or azygos vein flow measurement by thermodilution catheter, are invasive which has restricted their application. We describe a non-invasive cine phase contrast magnetic resonance technique for quantitative measurements of bulk volume flow and for demonstrating flow changes during the cardiac cycle in the azygos vein. The technique was used to analyse the azygos vein flow in seven adult volunteers and five patients with biopsy-confirmed chronic liver disease, portal hypertension and endoscopically proven oesophageal varices. In the volunteers the mean volume flow rates varied between 81 and 241 ml/min with a mean for the group of 171 ml/min. The patients had a significantly higher mean volume flow rate of 628 ml/min (p < 0.01), with a range of 339 to 945 ml/min. These preliminary results suggest that cine phase contrast magnetic resonance angiography is a practical non-invasive method for measuring absolute azygos vein flow, and may provide a non-invasive method of monitoring portal hypertension.
http://www.ncbi.nlm.nih.gov/pubmed/7665858

Could this be a way of diagnosing/screening the Azygous vein without doing a Venogram? Thoughts?

L wrote:

LR1234 wrote:I had a CT scan (and an MRV) but CT uses radiation and at quite high doses I think.

I have had two of them (again, and I don't want to moan too much, both unnecessary) and since reading about the radiation levels I am loathe to have another..

nancymno wrote:Dr. Sclafani - This is the first time I have posted. I have been following your thread since early April when I also contacted Holly to be put on your waiting list. Because my disability score has moved approximately 2 - 3 points (that would be upward) in the last 2 years and I am nearing or at a 6, I feel I don't have the time to get through waiting lists. By the time you or someone else get to me, I could be at 8.5 and ineligible. You are 700 miles from my home and it occurred to me I have never tried contacting an interventional radiologist in my own community. I gave it a shot and I have an appointment for a consultation next week. I am told by his nurse he has performed many balloon therapies on the jugular veins and stenting if necessary for other reasons. If he should be agreeable to doing this procedure (probably a big if), what does he need to know that might be different regarding an MS patient? Should I even take a chance on letting him do the procedure? (I have read your posts and have grown quite comfortable with the knowledge you have attained in this area. You have done several procedures and seem to have gained more and more expertise as you have done them). Is there anything special he needs to know about performing the procedure as it relates to MS? It could be he will not be receptive to the whole idea and I will remain on your waiting list, but I would like to be prepared.