Is anyone comparing ultrasound vs. venogram?

[bruce123]

I know that there are many imaging studies taking place. I’m wondering if there is a study that compares the Doppler ultrasound findings with the venogram findings of the same patients.

I ask this because it seems to me that many people end up being treated for more stenosis or reflux issues than is seen in the ultrasounds. In my wife’s case she tested negative for CCSVI in the pre-procedure ultrasound but she ended up having angioplasty in both IJV’s and benefited greatly. As a matter of fact, the doctor didn’t even look at the ultrasound before starting the procedure. This left me with the impression that they have limited trust in the ultrasound results (just my impression). I know that Albany goes ahead with the venogram regardless of the ultrasound findings. Is this the policy at all the treatment centers?

This also makes me wonder about follow-up ultrasounds. If they are missing a significant percentage of CCSVI problems then how much can I trust the findings if they say everything is OK? Of course it is best to have the follow-up ultrasound regardless but when the cost is $1000 with travel then it makes you stop and think. (Canadian eh)

Bruce.

[Cece]

There's going to be discussion of the ultrasound at ISNVD this month, maybe something will come of that.

The financial cost of it, at $1000, for ultrasound plus travel...I would have to consider that carefullly too.

I am wondering if d-dimer blood tests would be of use to monitor for clots? That should be possible for anyone without travelling, depending on the support of their local doctor. We don't want restenosis at all but of the types of restenosis, clotting is particularly worrisome because it can result in occlusion and loss of the vein, and if a d-dimer could measure for this reliably...?

[bruce123]

Cece, you never cease to amaze me.

I had no idea what a d-dimer was so here's the Wikapedia explination.

D-dimer is a fibrin degradation product, a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrinogen protein.[1]

D-dimer concentration may be determined by a blood test to help diagnose thrombosis. Since its introduction in the 1990s, it has become an important test performed in patients suspected of thrombotic disorders. While a negative result practically rules out thrombosis, a positive result can indicate thrombosis but does not rule out other potential causes. Its main use, therefore, is to exclude thromboembolic disease where the probability is low. In addition, it is used in the diagnosis of the blood disorder disseminated intravascular coagulation.[1]

Bruce.

[bigfoot14]

The Dr my wife used doesn't suggest ultrasound or MRV....he said that if we wanted them he would order the tests, but for CCSVI diagnosis, considered them a waste of time & money

He does, however, use ultrasound as a follow-up, just to make sure the blood is flowing

[Cece]

What I wonder about the d-dimer is if it only measures right when the clot is forming or if d-dimer levels would still be elevated if the clot occurred a month prior. I searched online for at-home d-dimer tests but, alas, no such thing. It's a test any general practioner should be be able to do. Dr. Dake required d-dimers of all his patients before he performed the procedure. ;)

Bigfoot, doesn't he need to have the pre-procedure imaging to serve as indication or justification for the insurance company to go forward with the procedure? (I imagine he doesn't, since he's doing it that way!)

[1eye]

This is one of the issues I would have hoped a non-loaded panel in Ontario would deal with. I get ultrasound for follow-up in Barrie, but it will not tell you anything about your azygos vein. Dr Sclafani probably uses both, but everybody can't be on his list. Dr. Siskin checks you out a day after, with Doppler. If you have a stent in your azygos, that's probably all right because I think the restenosis is low there, but is there any information about the rate of blood clots in stents? In different veins? Maybe we need something like a survey, or a paper to be published. I know it must be low, but a good stat would be handy. That blood test sounds like a good one if you are suspicious.

For gold-standard follow-up, do you need a fluoroscope? I think in Canada's current climate a doctor could not do it. Should you travel?

[bigfoot14]

Bigfoot, doesn't he need to have the pre-procedure imaging to serve as indication or justification for the insurance company to go forward with the procedure? (I imagine he doesn't, since he's doing it that way!)

He uses your symptoms as indicating veinous compression....

[DrCumming]

All modalities have their pluses and minuses. The more US I do the comfortable I am with it but still find I am missing some lesions at venography. Its an acquired skill and its why I personally do my own US vs having a tech. That being said, I have now seen several webs/membranes on US that we nearly invisible on venography. Only visible once a balloon was placed. So, both have problems, and making the diagnosis requires a high index of suspicion, patience, and looking hard.

I am looking forward to spending a day in Zamboni's lab at ISNVD. There is still much to be learned.....

[MegansMom]

The IR that did my daughter stated "we can do an ultrasound or MRV" but even if they are negative, with her symptoms we are gong to do the VENOGRAM, so save the money.

The insurance company Pre-approved the venogram and the angioplasties.
They probably would have covered the Pre-tests too, but I don't know if my daughters anxiety level would have.

[DrCumming]

I agree, I would not use either test to exclude preceding to venography +/- IVUS.

But, preprocedure US is useful. It gives a baseline non invasive image of the veins. It allows identification of the veins which can be useful in patients with small/hypoplastic veins. When doing the venogram, we are working upstream or backwards and it can hard to find the jugular occasionally or to know if you are indeed in the jugular vein (see Sal's case in the physician thread). Lastly, its a good tool for non invasive follow up. So I do not think its is waste.

All 3 modalities provide useful information. You need to interpret and utilize the results correctly to make good decisions.

[Loobie]

There is no comparison to the venogram. They are actually in there and looking at the vein.