This Is MS Multiple Sclerosis Knowledge & Support Community

Posted: **Tue May 15, 2012 12:34 pm**

http://www.biomedcentral.com/content/pd ... -12-26.pdf

Abstract

Background
Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by
anomalies of the primary veins outside the skull that has been reported to be associated with
MS. In the blinded Combined Transcranial (TCD) and Extracranial Venous Doppler
Evaluation (CTEVD) study, we found that prevalence of CCSVI was significantly higher in
multiple sclerosis (MS) vs. healthy controls (HC) (56.1% vs. 22.7%, p < 0.001).
The objective was to evaluate the clinical correlates of venous anomalies indicative of
CCSVI in patients with MS

Methods
The original study enrolled 499 subjects; 163 HC, 289 MS, 21 CIS and 26 subjects with other
neurological disorders who underwent a clinical examination and a combined Doppler and
TCD scan of the head and neck. This analysis was restricted to adult subjects with MS (RRMS:
n = 181, SP-MS: n = 80 and PP-MS: n = 12). Disability status was evaluated by using the
Kurtzke Expanded Disability Status Scale (EDSS) and MS severity scale (MSSS).

Results
Disability was not associated with the presence (≥2 venous hemodynamic criteria) or the
severity of CCSVI, as measured with venous hemodynamic insufficiency severity score
(VHISS). However, the severity of CCSVI was associated with the increased brainstem
functional EDSS sub-score (p = 0.002). In logistic regression analysis, progressive MS (SPMS
or PP-MS) vs. non-progressive status (including RR-MS) was associated with CCSVI
diagnosis (p = 0.004, OR = 2.34, CI = 1.3–4.2).

Conclusions
The presence and severity of CCVSI in multiple sclerosis correlate with disease status but has
no or very limited association with clinical disability.

The problem that I see is that if doppler is not the gold standard, it may be meaningless to make comparisons between patients found to have CCSVI by doppler and the patients not found to have CCSVI. We have the abstract from Siskin's team stating that the patients who had negative ultrasounds generally had positive findings when the catheter venogram was done. The finding by BNAC that 56% of patients with MS have CCSVI is out of line with what's being seen clinically.

Posted: **Tue May 15, 2012 1:13 pm**

The only thing that will satisfy this criticism is, I suggest, a trial with catheter venography and IVUS. It will be difficult to get healthy controls to do it. Perhaps people could be asked to participate, if they are already having angio for some other reason. There are lots of those every day.

Plethysmography: how does it compare as a diagnostic tool? How about Haacke MRVs?

I thought we had outgrown the Doppler, and were saying everybody with "MS" should have a cathether? Dye and IVUS would seem to be a minimum, for a reliable diagnosis.

If you want to use Doppler as a preliminary finger-in-the-air check, you might find something. There are very few false positives among "MS" patients. But since treatment necessitates angiography anyway, that should probably be the first line of attack in "MS" patients, especially those who have no other effective treatment modality.

Posted: **Tue May 15, 2012 2:39 pm**

The Siskin study plus my own experience suggest to me that the ultrasound is useless for detecting CCSVI. And even if it did work acceptably in the jugulars it cannot see anything in the azygos. You would still need to do the venogram for the azygos. So why bother? Just go straight to the venogram and save the cost of the ultrasound.

Posted: **Tue May 15, 2012 9:35 pm**

And.....which other veins can not be seen by doppler and have great influence in ccsvi???

Posted: **Wed May 16, 2012 2:09 am**

My understanding is that back flow is often seen on doppler (external) ultrasound. This is non invasive and says to get a full diagnosis (venogram and IVUS). Having said that my first procedure was straight for an invasive venogram (4 stenoses found and treated, good impact). Next I had a check up with a doppler ultrasound which showed I still had CCSVI. Then I had venograms and IVUS diagnosis and further de-stenosis (by Dr S), well worth it.
We should not dismiss Doppler as a screening tool in the hands of experts. However I would like to see neck collars used for initial screening as it does not require an expert.
MarkW

Posted: **Wed May 16, 2012 4:51 am**

David1949 wrote:The Siskin study plus my own experience suggest to me that the ultrasound is useless for detecting CCSVI. And even if it did work acceptably in the jugulars it cannot see anything in the azygos. You would still need to do the venogram for the azygos. So why bother? Just go straight to the venogram and save the cost of the ultrasound.

I agree. When my wife was treated in Albany they did not even look at the ultrasound results before proceeding with the venogarphy the following morning. When I asked why we had to pay for the ultasound when they simply ignored it as a diagnostic tool, I was told that it was useful as a baseline for future followup ultrasounds. I considered this a weak argument and question why I was not given the option to not pay for the ultrasound.

I would suggest that anyone considering the procedure should discuss this with their doctor. It may save them a lot of money. We never planned on getting a followup ultrasound. There is no use in seeing that the flow in compromised unless you are prepared to do something about it. Since we were not planning to have the procedure done again ($$$) then knowing if the flow was good or bad was irrelevant.

BTW, when we did get the results of the pre-procedure ultrasound it showed only 2 of the 5 criteria for CCSVI.

Bruce.

Posted: **Wed May 16, 2012 8:00 am**

My ultrasound showed the "veins were open and the blood was flowing". The venogram showed a very different picture. My left jugular narrowed down to only 3mm in the valve. The right jugular was 3mm over most of its length. So the ultra sound was not even close. The technicians seemed to be unfamiliar with the whole CCSVI concept. It may be that a technician who is well trained and skillful at finding CCSVI might do a much better job. But if such technicians are not available where the testing is done then the ultrasound is still useless.

Posted: **Wed May 16, 2012 8:29 am**

And I had almost the opposite experience. My US done by Barrie Vascular noted 3 criteria for CCSVI. Then my US done in Brooklyn noted 4 of 5 criteria for CCSVI.

Of course the rest is history. I guess what I am saying in a round about way is that I agree that it is only a bell weather test, if in fact results are so different between patients.
You have to go in there with venography and IVUS to get a complete picture, of that I am convinced.

tilt

This Is MS Multiple Sclerosis Knowledge & Support Community

latest BNAC research

latest BNAC research

Re: latest BNAC research

Re: latest BNAC research

Re: latest BNAC research

Back flow seen on external ultrasound

Re: latest BNAC research

Re: latest BNAC research

Re: latest BNAC research