Abstract
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.
Mike P Wattjes1, Bob W van Oosten2, Wolter L de Graaf1, Alexandra Seewann2, Joseph C J Bot1, René van den Berg1,3, Bernard M J Uitdehaag2,4, Chris H Polman2, Frederik Barkhof1
1Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
2Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
3Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
4Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Source: Journal of Neurology, Neurosurgery & Psychiatry with Practical Neurology Copyright © 2010 by the BMJ Publishing Group Ltd.(01/11/10)
I guess what the rearchers are saying is that what Zamboni was calling CCSVI MAY be nothing more than a veinuous system that is anatomically different but still works the way it is supposed too. I am not sure about a kick in the teeth but it is another independent study that seems to invalidate what we so far have learned about CCSVI. Hopefully the burden of proof will begin to fall on, as it should have from the beginning,Zamboni and his cohorts to PROVE that CCSVI exists instead of the other way around. It would certainly seem that with the severe neurological damage MS causes there should have been something that the radioologists saw on the doppler that would have indictated SOME kind of venuous involvement.Jugular wrote:This is the full abstract and it appears to me to be a major kick in the teeth for CCSVI.
Abstract
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.
Leonard wrote:this is an old study by Dutch doctors, among them neurologists. they are part of the same circles as Freedman et al.
it was first reported in July, now gets renewed visibility because it was put on-line end of October.
Zamboni comments on the Dutch study start around 4:00.
in summary, MRI is not the right methodology
I think that some people may have stronger veins (more Vit D during their childhood/ their mother metabolised more sun during pregnancy?), veins that are less susceptible to microbleedings. so, maybe, some people will also have stenoses but do not develop MS for that reason.
in any event, those with the weaker veins and MS benefit from liberation. that is the ultimate test! not whether other people happen to have stenoses and no MS.
What makes things even more confusing to me was that Zamboni's initial findings, which really started the CCSVI mania, were found using doppler. Yet now everyone is trying to invalidate this study by saying that doppler is not an accurate means of identifying CCSVI???Jugular wrote:I always thought that Doppler < MRV < Venogram, when it comes to detection tools.
According to this study, having a venous malformation and abnormal cranial drainage is not clinically relevant for MS because the same thing is as prevalent in the general population.
Is this something that has been proven or is it a wild guess?I think that some people may have stronger veins (more Vit D during their childhood/ their mother metabolised more sun during pregnancy?), veins that are less susceptible to microbleedings. so, maybe, some people will also have stenoses but do not develop MS for that reason.
Once again can you please let me know where you discovered that "those with weaker veins and MS benefit from liberation" Although there are some blinded studies in the woodworks, no one can make an ABSOLUTE claim about anything at this point.in any event, those with the weaker veins and MS benefit from liberation. that is the ultimate test! not whether other people happen to have stenoses and no MS.
scorpion wrote:What makes things even more confusing to me was that Zamboni's initial findings, which really started the CCSVI mania, were found using doppler. Yet now everyone is trying to invalidate this study by saying that doppler is not an accurate means of identifying CCSVI???Jugular wrote:I always thought that Doppler < MRV < Venogram, when it comes to detection tools.
According to this study, having a venous malformation and abnormal cranial drainage is not clinically relevant for MS because the same thing is as prevalent in the general population.
Leonard said:
Is this something that has been proven or is it a wild guess?I think that some people may have stronger veins (more Vit D during their childhood/ their mother metabolised more sun during pregnancy?), veins that are less susceptible to microbleedings. so, maybe, some people will also have stenoses but do not develop MS for that reason.
Leonard said:Once again can you please let me know where you discovered that "those with weaker veins and MS benefit from liberation" Although there are some blinded studies in the woodworks, no one can make an ABSOLUTE claim about anything at this point.in any event, those with the weaker veins and MS benefit from liberation. that is the ultimate test! not whether other people happen to have stenoses and no MS.
It's switched up: MRV<Doppler<Catheter venogram.Jugular wrote:I always thought that Doppler < MRV < Venogram, when it comes to detection tools.
According to this study, having a venous malformation and abnormal cranial drainage is not clinically relevant for MS because the same thing is as prevalent in the general population.
But it hadn't been published at that point I don't believe.eve wrote:The dutch research has been discussed in this thread:
http://www.thisisms.com/ftopic-12297-da ... tch-0.html
