Getting a handle

[1eye]

Evaluating the presence of abnormal venous vasculature
in a non-MS population using CT angiography
K. Agarwal, A. Agarwal, Y. Katkuri and E. M. Haacke

Department of Radiology, Wayne State University, Detroit, Michigan 48236


Introduction: There has been a major push in the last year to show that patients with multiple sclerosis (MS) have abnormal venous vasculature (1) and it has been shown directly by Interventional Radiologists (IRs) treating patients with angioplasty that many do in fact have problems with stenoses, bad valves or abnormal flow (2). The question remains, “How many normal individuals also have the same bad venous vasculature characteristics as those shown in MS?” To address this issue, we chose to retrospectively evaluate a set of 300 computed tomography angiographic (CTA) datasets to see how many people presenting with atherosclerosis or a variety of other symptoms exhibited venous abnormalities.

Methods: Institutional review board approval was obtained to evaluate retrospectively the CTA data. The patients were scanned in a 64 slice CT Scanner, utilizing about 100cc of Ultravist 370. Axial images were obtained with 1mm resolution. A total of 300 conventional CTA data were reviewed by two Radiologists and by a physicist or biomedical engineer on the local PACS system. The history of every case was reviewed to determine the cause of pathology if possible. Data were reviewed in the original axial (cranio-vertebral junction) region where the cutoff was 12mm. These two cutoffs were chosen to represent 70% stensosis of the jugular veins.

Results: Of the 300 cases reviewed, 36 were of non-diagnostic quality. Thirty-three (33) 33 cases had significant venous narrowing in at least one vein (8 of 33 had bilateral stenoses). Of these 33, 13 had trauma and one had suspected MS. Therefore, excluding the trauma data, 19 cases out of 250 cases were found to have abnormal veins or 7.6% of non-MS patients had venous stenosis. Of these 250 cases, 121 were imaged for suspected atherosclerosis and the rest had a variety of potential diagnoses including: stroke, infections, thyroid masses, etc. Nine out of 19 showing stenosis were from the atherosclerotic group (7.2%) while 10 of 19 were from the miscellaneous category (8%). No truncular venous malformations were observed in this group of 33 abnormal venous vasculature cases. However, 1 of the 9 atherosclerosis stenoses was of a beaded nature (multiple stensoses). Figure 1 shows an example of a normal appearing coronal data set and its transverse view. Figure 2 shows an example of an abnormal appearing coronal data set and its transverse view. plane and reformatted for both coronal and sagittal viewing. If there appeared to be any significant narrowing, the data were saved and then evaluated with SPIN to determine the cross sectional area of the purportedly narrowed or pinched region. Whenever patients had a prior scan both were reviewed and narrowing in both ensured that the data was used to quantify vessel cross section. Narrowing was called stenosis if the area of the jugular vein was less than 25mm unless the narrowing appeared in the C1/C2 (cranio-vertebral junction) region where the cutoff was 12mm. These two cutoffs were chosen to represent 70% stensosis of the jugular veins.

...figures omitted...

Fig. 1: Normal anatomy in coronal (a) and transverse views (b).
Fig. 2: Abnormal anatomy in sagittal view (c) and transverse view (d). In the normal cases jugular veins were of large caliber while in the abnormal cases we found narrowing (left white arrow in Fig. 2b) either unilateral or bilateral in 19 out of 250 cases.

Discussion and Conclusion: There are reports by interventional radiologists stating that the rate of abnormal vasculature as seen using angiography is between 80 and 97%. Reports from those using MR venography (MRV) are less supportive of this (but MRV is far from the gold standard of angiography) that only 56% of MS patients show venous abnormalities while 22% of normals do show problems (3). This larger fraction of normals that met the five Zamboni criteria may be explained by the fact that in their study the normal population was often chosen from relatives of the MS patients. Our results indicate that even for people with other suspected diseases, the rate of abnormal venous stenosis is only 7.6%. What role these venous abnormalities may play in this cohort of 19 patients is unclear, but it demonstrates that the prevalence of stenoses in
the non-MS population is low and certainly much smaller than that observed by others in the MS population.

References:
[1] Zamboni P et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J
Neurol Neurosurg Psychiatry. 2009;80:392-399.
[2] Ludyga T et al. Endovascular treatment for chronic
cerebrospinal venous insufficiency: is the procedure safe? Phlep In Press. 2010.
[3] Zivadinov R et al. Use of MR venography for characterization of the extracranial venous system in patients with MS and
healthy control subjects. Radiology, 2010, in press.

[CCSVIhusband]

It's easy to quickly dismiss such a statement from a quick reading of the abstract. Perhaps it's not so easy once you've read the full paper and examined the 44 or so cited references (many of which directly address the issue of reduced cerebral perfusion in PwMS).

I can see where you're coming from, I honestly can, but I only have so much time to spend studying and what I want to spend my time on is the hygiene hypothesis, Tovaxin (not much going on in that front) and rebooting the immune system.

As mentioned before, considering that more than 90% of new theories amount to nothing and the theory of CCSVI mistakenly was bumped to the front of the line and still has the odds greatly against it, I'm not going to waste my time with HOW CCSVI works when IF IT WORKS hasn't been proven and concern for that is a better use of time.

OK ... so WHY do you spend so much time posting in the CCSVI forum compared to the other forums?

[MegansMom]

It's easy to quickly dismiss such a statement from a quick reading of the abstract. Perhaps it's not so easy once you've read the full paper and examined the 44 or so cited references (many of which directly address the issue of reduced cerebral perfusion in PwMS).

I can see where you're coming from, I honestly can, but I only have so much time to spend studying and what I want to spend my time on is the hygiene hypothesis, Tovaxin (not much going on in that front) and rebooting the immune system.

As mentioned before, considering that more than 90% of new theories amount to nothing and the theory of CCSVI mistakenly was bumped to the front of the line and still has the odds greatly against it, I'm not going to waste my time with HOW CCSVI works when IF IT WORKS hasn't been proven and concern for that is a better use of time.

If you are continuously posting on this thread ( with inflammatory postings) after you skim articles instead of reading thoroughly the ongoing studies completely I for one will be skipping your posts.
I was always giving you credit for being an informed skeptic but you suffer from Semmelweis reflex. A bad case.

[Lyon]

OK ... so WHY do you spend so much time posting in the CCSVI forum compared to the other forums?

I've never kept it a secret and have stated the reasons 10 or 15 times which I would link to if I had more time. Here are a couple of instances from the same thread recently http://www.thisisms.com/ftopicp-148132.html#148132

As is often mentioned, it seems necessary to constantly repeat that the constant corrections by the skeptics isn't for the benefit of the "squeaky wheels" here at thisisms but instead is for the benefit of the naive who have wrongly heard that this is the place to come for "accurate" information about the theory of CCSVI and might otherwise believe the fairy dust spread around here shares some similarity with the truth.

http://www.thisisms.com/ftopicp-148144.html#148144

As mentioned mere minutes ago, my efforts are for the naive who come here and, if uncontested, would think that something they hear here might actually resemble the truth.

[formyruca]

for the benefit of the naive

It didn't work for me... I doubt it is working for others.

Just thought you would like some feedback from the naive crowd.

[Lyon]

It didn't work for me... I doubt it is working for others.

Just thought you would like some feedback from the naive crowd.

Thank you. I'll consider you a disappointment.

[fernando]

Well, when I see you saying the same thing about ingesting worms (or any other therapy besides dmd's) , I will believe you.

OK ... so WHY do you spend so much time posting in the CCSVI forum compared to the other forums?

I've never kept it a secret and have stated the reasons 10 or 15 times which I would link to if I had more time. Here are a couple of instances from the same thread recently http://www.thisisms.com/ftopicp-148132.html#148132

As is often mentioned, it seems necessary to constantly repeat that the constant corrections by the skeptics isn't for the benefit of the "squeaky wheels" here at thisisms but instead is for the benefit of the naive who have wrongly heard that this is the place to come for "accurate" information about the theory of CCSVI and might otherwise believe the fairy dust spread around here shares some similarity with the truth.

http://www.thisisms.com/ftopicp-148144.html#148144

As mentioned mere minutes ago, my efforts are for the naive who come here and, if uncontested, would think that something they hear here might actually resemble the truth.

[Lyon]

Well, when I see you saying the same thing about ingesting worms (or any other therapy besides dmd's) , I will believe you.

You haven't been around long enough because it's already happened. Much of it searchable here at thisisms and also a bit at the old Ovamed forum.

[1eye]

Just thought you might want to hear from the non-naive, jaded crowd. It works for me. I think it is working for a lot of others. Probably a majority of the over 12000 people who have been treated with venoplasty.

What I see happening here is someone attempting, in the face of incredible amounts of evidence to the contrary, to maybe keep a few people from the great wisdom of getting treated by doctors.

It masquerades as non-medical advice, even has a disclaimer saying it isn't medical advice at the bottom, but over the past year I have seen you, Lyon and a known group of userids here freely dispensing the medical advice that CCSVI is hooey that you should stay away from, repeating the fabrication that the evidence is "not there". (I like Dr. Sclafani's question: "Are we there yet?") For some people, there will never get here.

I have no doubt that your legal liabilities are coated in a shroud of friendly skepticism. The reality is you have an agenda, which you try to hide. The result is that those very naive people you profess to want to help get nothing but discouragement from your incessant repetitions. If you do manage to convince someone not to address what is known to be a debilitating medical problem with a known working solution, in the guise of healthy doubt, you have done them a grave harm. No disclaimers can hide that. There are people dumb enough to believe you, and you should stop taking advantage of their ignorance. For the life of me, along with many here, I am sure, I cannot imagine why you do this.

The excuse that you did not have time to read the evidence will not wash. It has come from many directions, near and far. Dr. Duncan said that a political process was used not to do science. I think this forum is being used to confuse people who are already confused enough, by neurologists, drug vendors, and politicians, all with fairly obvious self-serving agendas. Yours is not so obvious. Please let them alone.

Even if they don't declare their conflicts of interest, at least the neurologists, politicians, and drug vendors identify themselves. The doctors practicing this procedure also courageously do what they do in public, too, in the light of day. If asked, I will identify myself, and have on several occasions. My identity is no secret, any more than Dr. Sclafani's is. I also have declared my interest: I have been told I have "SPMS". I am also not interested in hearing any more about people who have died waiting, if that can be considered a conflict.

Perhaps you do not consider that to apply to you, since you live in a free country, but I am still hearing about the "no IRB approval" situation in some parts of your country too. This is very deadly foot-dragging, death by omission. If you are still skeptical, can you please be a little quieter about it? Spend some time reading Cheerleader's web site. Read, don't scan, all the papers pointed to by people on this site, not just the ones about placebo, but all of them. Do as I have done, if you don't have an institutional subscription, and buy the papers so you can read more than the abstracts. When you're done reading, maybe you will want to correspond by PM with other people who share your negativity. Or who knows, maybe you will just shut up.

[Lyon]

Despite the fact that everything you've said is without merit, the one thing beyond question is that you can pound the keys with the best of them!

Obviously your word for 2011 is "delusional".

[fernando]

Well, when I see you saying the same thing about ingesting worms (or any other therapy besides dmd's) , I will believe you.

You haven't been around long enough because it's already happened. Much of it searchable here at thisisms and also a bit at the old Ovamed forum.

Well, you just have given a counter example to your own words.

[scorpion]

Just thought you might want to hear from the non-naive, jaded crowd. It works for me. I think it is working for a lot of others. Probably a majority of the over 12000 people who have been treated with venoplasty.

What I see happening here is someone attempting, in the face of incredible amounts of evidence to the contrary, to maybe keep a few people from the great wisdom of getting treated by doctors.

It masquerades as non-medical advice, even has a disclaimer saying it isn't medical advice at the bottom, but over the past year I have seen you, Lyon and a known group of userids here freely dispensing the medical advice that CCSVI is hooey that you should stay away from, repeating the fabrication that the evidence is "not there". (I like Dr. Sclafani's question: "Are we there yet?") For some people, there will never get here.

I have no doubt that your legal liabilities are coated in a shroud of friendly skepticism. The reality is you have an agenda, which you try to hide. The result is that those very naive people you profess to want to help get nothing but discouragement from your incessant repetitions. If you do manage to convince someone not to address what is known to be a debilitating medical problem with a known working solution, in the guise of healthy doubt, you have done them a grave harm. No disclaimers can hide that. There are people dumb enough to believe you, and you should stop taking advantage of their ignorance. For the life of me, along with many here, I am sure, I cannot imagine why you do this.

The excuse that you did not have time to read the evidence will not wash. It has come from many directions, near and far. Dr. Duncan said that a political process was used not to do science. I think this forum is being used to confuse people who are already confused enough, by neurologists, drug vendors, and politicians, all with fairly obvious self-serving agendas. Yours is not so obvious. Please let them alone.

Even if they don't declare their conflicts of interest, at least the neurologists, politicians, and drug vendors identify themselves. The doctors practicing this procedure also courageously do what they do in public, too, in the light of day. If asked, I will identify myself, and have on several occasions. My identity is no secret, any more than Dr. Sclafani's is. I also have declared my interest: I have been told I have "SPMS". I am also not interested in hearing any more about people who have died waiting, if that can be considered a conflict.

Perhaps you do not consider that to apply to you, since you live in a free country, but I am still hearing about the "no IRB approval" situation in some parts of your country too. This is very deadly foot-dragging, death by omission. If you are still skeptical, can you please be a little quieter about it? Spend some time reading Cheerleader's web site. Read, don't scan, all the papers pointed to by people on this site, not just the ones about placebo, but all of them. Do as I have done, if you don't have an institutional subscription, and buy the papers so you can read more than the abstracts. When you're done reading, maybe you will want to correspond by PM with other people who share your negativity. Or who knows, maybe you will just shut up.

I ask for this again and again when someone claims that such statements' were made but NO ONE is ever able to produce anything I said or Lyon said telling someone not to get the procedure or any statement even close to saying that "CCSVI is hooey". Once again, if anyone can reference a post where either of us made such a statement please do so. We aint be hatin' on CCSVI 1Eye only waitin for more proof. If asking occasional critical questions on this board is a problem then I am guilty! Really we do not post on here very often,maybe on one or two threads per week, but when we do all hell breaks loose.

[Coolcatcarrie]

ieye - i like your post and I agree!

[Lyon]

I ask for this again and again when someone claims that such statements' were made but NO ONE is ever able to produce anything I said or Lyon said telling someone not to get the procedure or any statement even close to saying that "CCSVI is hooey". Once again, if anyone can reference a post where either of us made such a statement please do so. We aint be hatin' on CCSVI 1Eye only waitin for more proof.

First, although you shouldn't have to constantly repeat yourself, well said.

Second, excellent use of the language of the jive!

[1eye]

only waitin for more proof

The longer we allow the "myths" surrounding CCSVI to linger the longer it will take for us to get clear cut answers as to the validity of CCSVI.

Longer. Much longer. Clarity sometimes depends on the direction you look, and whether you are blind. You keep waitin, won't you? There's some 'myths' around here I wish would linger no longer, that's for sure.