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Research paper:

"No association of abnormal cranial venous drainage with multiple sclerosis: a magnetic resonance venography and flow-quantification study"

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Abstract
Full text - PDF
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Background
Recent studies using colour-coded Doppler sonography showed that chronic impaired venous drainage from the central nervous system is almost exclusively found in multiple sclerosis (MS) patients. This study aimed to investigate the intracranial and extracranial venous anatomy and the intracerebral venous flow profile in patients with MS and healthy controls using magnetic resonance venography (MRV).

Methods
Twenty patients with definite MS and 20 age- and gender-matched healthy controls were examined. MR imaging was performed on a whole-body 3T MR system including both 3D phase-contrast and dynamic 3D contrast-enhanced MRV as well as flow quantification of the internal cerebral veins and the straight sinus. Image analysis was performed by two experienced interventional neuroradiologists blinded to clinical data and structural brain imaging. The intracranial and extracranial neck veins were analysed for stenosis/occlusion and alternative venous drainage pattern.

Results
A completely normal venous anatomy was observed in 10 MS patients and 12 controls. Anomalies of the venous system (venous stenosis/occlusions) were found in 10 MS patients and eight healthy controls. An anomalous venous system in combination with associated alternative venous drainage was observed in six MS patients and five healthy controls. Flow quantification showed no venous backflow in any MS patient or control.

Conclusions
Findings suggestive of anomalies of the cranial venous outflow anatomy were frequently observed in both MS patients and healthy controls. Given the normal intracranial venous flow quantification results, it is likely that these findings reflect anatomical variants of venous drainage rather than clinically relevant venous outflow obstructions.

I believe this is the same study that was in that thread that recently got locked.

A similar study is currently underway at the 'False Creek Surgical Centre' - Vancouver, B.C. Canada
100 MSer's - 100 Healty Controls

http://www.falsecreekdiagnostics.com/cc ... low-study/

Cog fog is bad enough without mind games too. I would like to know who is who.

There is a role among us for people who are not 100% convinced of the validity of CCSVI and its implications for people with MS. I appreciate those who are able to make their points with respect and those who are able to respond in kind.

If I believed the nay-sayers I would need to accept that I am no longer a UK registered pharmacist (in the UK you are either a pharmacist or are forbidden from using this restricted title).

I am prepared to have my photo and home location published in a UK national daily paper and tell my story.

MarkW

Same thread topic, hopefully now with substantially reduced sarcasm.

This study, if it holds up is very damaging to CCSVI theory, particularly since one of the more compelling aspects of it is the claimed 'robust' correlation between abnormal cerebral drainage and MS.

There are a number of odd things about it though that I would like to see addressed before attaching too much weight to it:

1. Small sample size - 10 MS patients 10 controls;

2. The figures used to illustrate the stenoses, seemed out of sync with what other researchers are finding for malformations leading me to comment facetiously that perhaps the Dutch are simply beautiful people with lovely veins. To illustrate this point three of us (Cheerleader (Jeff), me and Johnson) posted our own UG JUG MRV's; and

3. The blood flow analysis was not the same as Haacke's. The flow was measured in the cerebral vein in one location rather than the neck level at two different locations.

The later two points Cheerleader said she was going to ask Haacke about. I am very interested in his comments about this study since he has looked at hundreds (if not more) of MRV's and uses a different protocal for blood flow quantification.

Jug: This study, if it holds up is very damaging to CCSVI theory
MW: This study did not use the method that vascular specialists say is needed to diagnose stenosis - selective venography. In science if you use the wrong method you get funny results. Dutch study is worthless for this reason alone. The Dutch study will be quoted by neuros and the turf war will continue.

Jug: Small sample size - 10 MS patients 10 controls;
MW: it was 20 and 20 but compared with 2000+. the Dutch results are just outliers due to poor methology in my opinion.

Jug: The figures used to illustrate the stenoses, seemed out of sync with what other researchers are finding for malformations leading me to comment facetiously that perhaps the Dutch are simply beautiful people with lovely veins. To illustrate this point three of us (Cheerleader (Jeff), me and Johnson) posted our own UG JUG MRV's;
MW: The issue with MRVs is that unless you are an expert (Prof Haacke)
they are not a conclusive diagnosis.

Jug: The blood flow analysis was not the same as Haacke's. The flow was measured in the cerebral vein in one location rather than the neck level at two different locations.
MW: This study did not use selective venography and varied Haacke's method, why ? Repeating - if you use the wrong method you get funny results. Dutch study is worthless on many levels.

MW: The vascular experts have published the requirement to use selective venography for a definite diagnosis. Unless MRV is used by an MRV expert I would disregard any results using these methods. Also how does MRV detect stenoses in veins in the trunk ?

MarkW

MarkW wrote:Also how does MRV detect stenoses in veins in the trunk ?

It does not. Only doppler ultrasound done by an expert can indirectly detect the hemodynamic flow disruptions caused by CCSVI in the azygous. And I am not completely convinced that it can either.

Oops on the study size.

I think MRV imagry has some legitimacy too it in its its ability to image the veins (including, but not as well, the azygous vein) and precisely measure flow. Dr. Haacke certainly thinks so. That is why I would like to hear his comments on this study.

For now, this is a published study in a peer-reviewed medical journal. Anecdotal evidence will not prevail over it in the mind of mainstream medicine. If the study holds up it is devasting to CCSVI theory since it found that stenosed veins were no more common in MS patients and not associated with any pathology.

We need a good answer to it.

MarkW wrote:Also how does MRV detect stenoses in veins in the trunk ?

The same way it detects stenoses in the IJVs, or other veins. The problem, as I understand it, is artifacts of breathing. I was asked not to breathe at certain points in my MRV(s), but in my first, it appeared that I had bifurcated azy., which was not the case during PTA.

Cece wrote:It does not. Only doppler ultrasound done by an expert can indirectly detect the hemodynamic flow disruptions caused by CCSVI in the azygous. And I am not completely convinced that it can either.

Are you sure about that? I only ask because during my own DUS(s) (Zamboni-trained tech.), the only area investigated was my neck - from jaw to clavicle. Dr.s Simka and Ludigya never went anywhere with DUS but my neck either.

Has anyone had a DUS view of their azygous?

Johnson wrote:

Cece wrote:It does not. Only doppler ultrasound done by an expert can indirectly detect the hemodynamic flow disruptions caused by CCSVI in the azygous. And I am not completely convinced that it can either.

Are you sure about that? I only ask because during my own DUS(s) (Zamboni-trained tech.), the only area investigated was my neck - from jaw to clavicle. Dr.s Simka and Ludigya never went anywhere with DUS but my neck either.

Has anyone had a DUS view of their azygous?

It came up in drsclafani's thread a few days ago, I can find the link:

http://www.thisisms.com/ftopicp-139855.html#139855

drsclafani wrote:

Cece wrote:While I agree with what Dr. Sclafani said above about the Doppler findings for the jugulars, the azygous cannot be imaged outside of a catheter venogram, and the azygous is an area in which the different docs have different techniques and expertise.

the doppler measures hemodynamic effects of abnormal venous return from the spine and brain. Abnormal doppler has been shown to be associated with azygos flow. Not to say that the doppler images the veins of the spinal cord anatomy. rather it measures the hemodynamics.

Jugular wrote:Same thread topic, hopefully now with substantially reduced sarcasm.

Same study, but now with a full research paper, not only the abstract:
http://jnnp.bmj.com/content/early/2010/ ... 9.full.pdf
(Published online October 27, 2010 in advance of the print journal.)
Locked thread comments was based only on abstract.

Jugular wrote:There are a number of odd things about it though that I would like to see addressed before attaching too much weight to it:

1. Small sample size - 10 MS patients 10 controls;

Authors comment:

...
A limitation of our study is the limited number of MS patients
and healthy control subjects, which limits the ability to draw
definite conclusions. The sample size number was based on the
suggested almost absolute difference in presence of venous
abnormalities between MS patients and healthy controls.
Nevertheless, the present sample size would allow one to find
a difference of 50% or more with a power of about 0.8. In addition,
our results based on MRV have not been confirmed or
refuted by another imaging modality such as Doppler sonography.
However, our study represents the largest caseecontrol
dataset of MRV in the evaluation cranial venous outflow in MS
patients and healthy controls so far. Given the fact that the initial
results suggesting that MS is associated with a pathological
venous outflow anatomy presented sensitivity, specificity, positive
and negative predictive values of 100%, our study population
is large enough to refute these data.
...

I also perfomed a study to disprove Dr. Zamboni theory that MRV is unreliable to diagnose CCSVI because of high false positive and false negative results.


As you can see my right jugular vein (on the left side of the picture) is much smaller then the normal jugular vein on the other side so it is obvious that I have CCSVI based on the above MRV.

A limitation of my study is the limited number of MS patients
( one, me) and no healthy control subjects, which limits the ability to draw
definite conclusions.( so what?) The sample size number was based on the
suggested almost absolute difference in presence of venous
abnormalities between MS patients and healthy controls.
Nevertheless, the present sample size would allow one to find
a difference of 100% or more with a power of about 0.8. In addition,
our results based on MRV have not been confirmed or
refuted by another imaging modality such as Doppler sonography.(Dr. Zamboni standard method to detect CCSVI)
However, my study represents the second largest casecontrol
dataset of MRV in the evaluation cranial venous outflow in MS
patients and no healthy controls so far. Given the fact that the initial
results suggesting that MS is associated with a pathological
venous outflow anatomy , (also confirmed by thousands of catether contrast venography done up to date), presented sensitivity, specificity, positive
and negative predictive values of 100%, my study population
is large enough to confirm these data.

Please let me know if I should publish my study.
Thanks for your attention.

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