here is the abstract:
[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
As described in the Medpage article, the patients found to have CCSVI by MRV did not have CCSVI by doppler; and the patients found by doppler did not have CCSVI by MRV, which lends some confusion as to whether the imaging methods were accurate, since they did not agree with each other.
According to Cheer on the CCSVI in MS page, this group did not use Dr. Zamboni's ultrasound methods.
And I hope Marie does not mind me copying her explanation of why it matters what ultrasound method is used:
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?
