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Mark Freedman, MD, of the University of Ottawa in Ontario, pointed out after Barreto's presentation that serial ultrasound scans would have made the findings more reliable, as venous sonography results tend to be variable within patients.

Nevertheless, he told MedPage Today, CCSVI had already been essentially ruled out as a contributor to MS.

"There are just some people who are convinced that neurologists don't know what they're doing. The data [that CCSVI is unrelated] is pretty convincing," Freedman said.

Asked if there was a role for using a series of imaging studies -- ultrasound followed by MR and CT venography, for example, he responded, "You know the expression about a dead horse?"

[S10.005] A Study of CCSVI with Imaging-Blinded Assessment: Neurosonography Update

Andrew Barreto, Staley Brod, Thanh-Tung Bui, James Jamelka, Larry Kramer, Kelly Ton, Alan Cohen, John Lindsey, Flavia Nelson, Ponnada Narayana, Jerry Wolinsky, Houston, TX



OBJECTIVE: Does chronic cerebrospinal venous insufficiency (CCSVI) exist, is it associated with multiple sclerosis (MS), and what tools might establish its presence? We sought to determine if neurosonography (NS) provides reliable information on cerebral venous outflow patterns, if NS findings are supported by 3T magnetic resonance venography (MRV), and if NS and/or MRV reflect transluminal venography findings. We detail NS findings on the first 193 participants.

BACKGROUND: CCSVI is postulated to have a role in MS pathogenesis.

DESIGN/METHODS: TB, blind to the subject's diagnosis, used high resolution B-mode imaging with color and spectral flow Doppler to investigate extracranial and intracranial venous drainage. Results were evaluated by ADB with neither subject contact nor patient information; only KT and JSW could access the complete database.

RESULTS: 10 healthy controls, 18 cerebrovascular diseases, 27 other neurological diseases, 138 MS (7 clinically isolated syndrome, 80 relapsing remitting, 35 secondary progressive, 15 primary progressive, 1 progressive relapsing) were studied. MS patients were older than non-MS subjects (48.4±9.8 v 44.3±11.4 years), durations from first symptoms and diagnosis of 13.7±9.4 and 10.3±8.0 years, and EDSS 2.9±2.0. 47 subjects fulfilled one of five criteria for CCSVI proposed by Zamboni; 8 fulfilled two criteria and none fulfilled >2 criteria. The distribution of subjects with 0, 1 or 2 criteria did not differ significantly across all diagnostic groupings, between MS and non-MS subjects, or within the MS subgroups. No significant differences emerged between MS and non-MS subjects for measures of cross-sectional areas of the internal jugular veins at fixed anatomic sites or for extracranial or intracranial venous flow rates.

CONCLUSIONS: NS findings described as CCSVI are much less prevalent than previously reported and do not distinguish MS from other subjects. Data will be updated prior to the meeting. Correlations of NS and MRV for 37 MS subjects are reported separately. Supported by: National Multiple Sclerosis Society (RC 1019-A-5).Category - MS and Related Diseases: Clinical Science

this is marie-we knew this was the achilles heel of CCSVI from the first months when several of us tried to get dopplers locally...I did get some at the U. of Wash in the vascualr surgery department with and expert doppler tech who'd studied Zamboni's papers. He did see reflux in the vertebral veins, but not the "Zamboni criteria" for CCSVI. Then I went too Stanford the week after Jeff and Dr Dake had their doppler tech do Zamboni style scans and the snotty tech who was derisive if the whole thing said my scane were utterly completelly normal. There was absolutely nothing at all amiss and not even the vertebral veins the UW saw. The next morning I had a venogram and both jugulars were blocked 90%.

I had dopplers done by Eric Fiegenbutz two years later to check my post treatment blood flow--he was directly trained in Zamboni methods and owns his own chain of clinics. He found reflux in my deep veins right away (my stent is blocked). I asked him if he could have figured out the Zamboni stuff without the training he said no not at all. It took the two weeks training for him to understandf fully what theya re looking for. It isn't the normal thing, what you look for is subtle not gross differences and you simply let the litttle blips pass you by without training.

Dopplers are a completely ridiculous waste of time and money UNLESS done by people trained. I wrote about this problem and predicted this in my book 2 YEARS AGO. I'm just a nurse, how come neurologists don't get this?

Diagnostic accuracy of current sonographic criteria for the detection of outflow abnormalities in the internal jugular veins.

Simka M, Ludyga T, Latacz P, Kazibudzki M.

Journal Phlebology.
2012 Apr 23. [Epub ahead of print]

Affiliation EUROMEDIC Specialist Clinics, Department of Vascular & Endovascular Surgery, Katowice, Poland.

Abstract

OBJECTIVES: This study was aimed at evaluation of the diagnostic value of Doppler sonography for the assessment of abnormalities in the internal jugular veins (IJVs).

METHOD: One hundred and sixteen IJVs were assessed in 58 patients with associated multiple sclerosis. Findings of Doppler sonography were compared with results of the reference test: catheter venography.

RESULTS: At least one positive extracranial sonographic criterion suggesting venous abnormality was found in 92.2% of the assessed veins. Yet, sensitivity, specificity, positive and negative predictive values of sonography were low: 93.4%, 12.0%, 79.4% and 33.3% for at least one positive criterion, and for at least two positive criteria: 29.3%, 75.0%, 81.8% and 21.7%, respectively.

CONCLUSIONS: Our research has shown that currently used extracranial sonographic criteria for the detection of obstructive venous abnormalities in the IJVs are of limited diagnostic value. For the time being, diagnosis of this vascular pathology should be given using catheter venography.

PMID 22528692 [PubMed - as supplied by publisher]

Robnl wrote:Totally right CeCe.....while ccsvi-experts are trying to optimize diagnosis, some doctors are trying to ''dismiss' ccsvi....weird isn't it??