MRV - aren't they all the same?

CureOrBust · Post by **CureOrBust** » Thu Jan 07, 2010 2:41 am

Alex, Dr Haake is VERY interested in getting centres around the world, set up to perform the scans. If you get your radiologist / Dr to contact Dr Haake, I am SURE he would provide all the help he could.

thisisalex · Post by **thisisalex** » Thu Jan 07, 2010 3:10 am

That is what i would like to organize

But first i have to get my radiologist interested. It is an MR research center and now he has all the neccessary papers to read, and he promised me to make a Haacke MRV...
i will keep you informed

alex

CureOrBust wrote:Alex, Dr Haake is VERY interested in getting centres around the world, set up to perform the scans. If you get your radiologist / Dr to contact Dr Haake, I am SURE he would provide all the help he could.

astro · Post by **astro** » Thu Jan 07, 2010 8:50 pm

I recently received a script which simply states "MRV of Head and Neck." It is to be done at a local hospital. The prescribing doc is aware of the CCSVI theory, but disagrees with part of the Zamboni protocol and says they will not be following it exactly. Kind of like "Let's do this first, and see what we get."

I don't quite understand how this differs from Zamboni, since "MRV of Head and Neck" seems to be a pretty broad order. I also have a script for "Venous Duplex Ultrasound - Head and Neck."

Am I wasting my time in getting this test? What could my doc possibly disagree with in Zamboni's protocol, and why would they want to diverge from it, given the goal at this point is to independently verify Zamboni's findings?

thisisalex · Post by **thisisalex** » Fri Jan 08, 2010 12:13 am

astro wrote:The prescribing doc is aware of the CCSVI theory, but disagrees with part of the Zamboni protocol and says they will not be following it exactly.

Astro,

what do you mean by the Zamboni protocol? the ultrasound protocol?

the ultrasound is tricky, the radiologist must perfectly follow the protocol, even better the Simka protocol
http://csvi-ms.net/en/content/how-perfo ... t-dr-simka

the MRV is not so tricky an ordinary MRV (including the neck!) could be good if you have something very big mistake in your veins

but if we are just looking for small turbulences, or small stenosis, the radiologist MUST to know what to look for.
here is the MR protocol: http://ms-mri.com/potential.php

alex

Algis · Post by **Algis** » Fri Jan 08, 2010 12:19 am

Membranes and/or reverted valves are only detected by Doppler if I am correct?

astro · Post by **astro** » Sat Jan 09, 2010 8:27 am

thisisalex wrote: Astro,

what do you mean by the Zamboni protocol? the ultrasound protocol?

After some further digging, I learned that my scan will not include a venogram, the idea being that this is more invasive. I am all for a cautious approach which begins with non-invasive MRV and ultrasound, but am concerned that it will provide a false negative, and get a nice "pat on the head" from my neuro.

CureOrBust · Post by **CureOrBust** » Sat Jan 09, 2010 6:03 pm

Algis wrote:Membranes and/or reverted valves are only detected by Doppler if I am correct?

During an MRV, i believe they can take flow measurements at a particular point. Therefore, if done "properly" (ie they are specifically / looking for it) an MRV should be able to find these also.

Dr Haake's protocol takes flow quantification at various points. Doppler can not get flow measurements behind bone.

mrsilkykat · Post by **mrsilkykat** » Sun Jan 10, 2010 12:39 pm

This is a terrific thread and pairs well with ozarkcanoer's thread "kinds of venous malformations..."

http://www.thisisms.com/ftopic-9663.html

Algis · Post by **Algis** » Sun Jan 10, 2010 7:34 pm

CureOrBust wrote: ........... Doppler can not get flow measurements behind bone.

Is this why it is called "transcranial" Doppler

CureIous · Post by **CureIous** » Sun Jan 10, 2010 8:57 pm

astro wrote:
thisisalex wrote: Astro,

what do you mean by the Zamboni protocol? the ultrasound protocol?

After some further digging, I learned that my scan will not include a venogram, the idea being that this is more invasive. I am all for a cautious approach which begins with non-invasive MRV and ultrasound, but am concerned that it will provide a false negative, and get a nice "pat on the head" from my neuro.

Correct, we won't be seeing any mass venograms in this lifetime, and the MRV's may or may not show structural abnormalities, and the UT may or may not show any flow issues, so all we can do at this point, is walk in with as much info as possible and hope they play ball to some extent.

Some like the lady I spoke with tonight, got the circular file right off the bat from the neuro. *shocking*.

Anyways I was coming back to post up about the transcranial, just a copy from wiki which should be helpful to clear the air. It took years of diligent study to get my PhD as a CopyPastist. ;)

Mark.

Wiki Link

...Because the bones of the skull block the transmission of ultrasound, regions with thinner walls - insonation windows - must be used for analyzing. For this reason, recording is performed in the temporal region above the cheekbone/zygomatic arch, through the eyes, below the jaw, and from the back of the head. Patient age, gender, race and other factors affect bone thickness, making some examinations more difficult or even impossible. Most can still be performed to obtain acceptable responses, sometimes requiring using alternate sites from which to view the vessels.

Algis · Post by **Algis** » Sun Jan 10, 2010 9:16 pm

Places that Doppler can reach in the cranium.

CureIous · Post by **CureIous** » Sun Jan 10, 2010 9:25 pm

Why's that guy getting a UT, his veins look perfect! ;)

Good pic tho...

whitematter · Post by **whitematter** » Wed Jan 13, 2010 12:41 am

jenf wrote: Yes, I just asked if they had a 3d machine... They were obviously a little confused and kept asking if I meant 3T. Not sure what the differences are; I have NO medical background what-so-ever!

Hi all, I'm new on this board. I live in Berkeley, CA. Diagnosed with RRMS in 2005.

3T must mean 3 Tesla, the strength of the magnetic field in the machine. I also have no medical background, but I do have a background in physics. The typical MRI machine, at least the one used for brain scans, generates a magnetic field with the flux density on the order of 1 - 1.5T. The ones used for medical research go up to about 10T. A stronger field provides better resolution.

I actually signed up hoping to find out how to get tested.

I spoke to my neurologist yesterday about getting this test. She said she had not heard of the CCSVI hypothesis and asked me to give her the copies of Zamboni's papers, which I brought with me.

She was somewhat skeptical about it but very supportive. She said right away that it's hard to get a Doppler test done right and what I need is an MRV. But she was not sure what particular kind of MRV to order and said she'd look into it. She usually orders an intercranial MRV, and we both thought it might not be sufficient in this case. Or is it?

She ordered a regular MRI since I recently had some problems with vision etc. and she's considering switching me from Copaxone to Rebif. She said an MRV would be a separate test; she said she could write me a referral for a standard (intercranial) MRV but suggested that we figure out exactly what's needed first, which is a good idea, of course. But does it really need to be a separate test? Has anyone had this experience? I just looked at Dr. Haacke's protocol posted on ms-mri.com, and it appears that he's doing the tests together; on page 4 it says "add your institutional MS protocol". I usually get tested at UCSF and they do have an MS protocol.

She also thought that getting insurance authorization for anything other than an intercranial MRV might be difficult.

If anyone can share their thoughts on what to do or where to find further information beyond what's already been posted in this thread, I would really appreciate it.

mrsilkykat · Post by **mrsilkykat** » Sat Jan 16, 2010 11:58 am

Whitematter--Welcome! I don't have any info other than what's been posted in various sites on TIMS & Haacke. I agree, it's confusing.

However, I live in Berkeley and would like to get together to share info. I've been working with another MSer who also lives in Berkeley. We are trying to agree on the best protocol to work with. Let's talk. The more, the merrier.

I'm posting you a pm with my info.