This paper has been published in the American Society of Neuroradiology Journal. It is the first published research coming out of Buffalo as part of their angioplasty of CCSVI in pwMS. The title for this paper is underwhelming:
Value of MR Venography for Detection of Internal Jugular Vein Anomalies in Multiple Sclerosis: A Pilot Longitudinal Study
http://www.ajnr.org/cgi/reprint/ajnr.A2386v1.pdf?maxtoshow&hits=1&RESULTFORMAT&andorexacttitle=and&andorexacttitleabs=and&fulltext=ccsvi&andorexactfulltext=and&searchid=1&usestrictdates=yes&resourcetype=HWCIT&ct
I understand why this paper focuses on the use of MRV for diagnosis and follow-up of CCSVI --it is for a radiology journal, but can't we state what is being discovered is new. This is a ground-breaking study. Who cares if MRV isn't the best means of diagnosis and follow-up? What is important is that every single one of the pwMS tested had venous abnormalities that have been noted by Dr. Zamboni. WHAT MATTERS is the pwMS have venous malformations and this study is reproducing Dr. Zamboni's research. That's my title for the paper :)
Here are some selections from the paper:
Catheter Venography and PTA
Catheter venography was performed only in patients with MS after the Doppler sonography examination showed that all patients with MS fulfilled 2 venous hemodynamic criteria.1 It was performed via catheterization of the left iliac femoral vein and comprised visualization of the lumbar veins, left renal vein, azygous vein, and IJVs.3
Significant stenosis was considered to be any venous lumen reduction 50%.
We investigated the following IJV anomalies: annulus, a significantcircumferential stenosis of the venous wall; septum/valve malformation, anomalous valve apparatus causing significant flow obstacles at the level of the junction of the brachiocephalic trunk; membranous obstruction, a membrane almost completely occluding a vein; hypoplasia, an underdeveloped long venous segment; twisting, severe stenosis as a consequence of a twisted venous segment; and agenesis, complete anatomic absence of a venous segment.
Catheter venography was conducted by an interventional radiologist.
The presence of at least 1 of these anomalies in the IJVs was considered an abnormal examination finding when compared with MRV and Doppler sonography. Catheter venography was used as a criterion standard for comparison with MRV and Doppler sonography.
IJV Findings in Patients with MS and Healthy Controls
at Baseline and Follow-Up
Table 1 and Figs 1 and 2 show TOF, TRICKS, Doppler sonography, and catheter venography findings, at baseline and follow- up, in the left and right IJVs of patients with MS. At baseline, abnormalities were found in all patients with MS on Doppler sonography and catheter venography, in 30% of patients
on TOF, and in 40% on TRICKS. All patients presented with 2 venous hemodynamic criteria on Doppler sonography, and the mean number of venous hemodynamic criteria was 4. Catheter venography of the right IJV showed the presence of an annulus in 4 patients, a septum in 3 patients, and no abnormalities in 3 patients. Catheter venography findings of the patients with MS in the left IJV were the following: annulus (5), septum (3), membrane (1), malformed valve (1), and normal examination findings (1).
All patients with MS underwent PTA at baseline.
As far a doppler ultrasound is concerned, BNAC says you NEED TO BE TRAINED in Dr. Zamboni's protocol--
We previously reported that the inter-rater variability rate between trained and untrained Doppler sonography operators substantially increased after training was performed.11 The interobserver agreement between trained operators was much more reliable ( 0.80) compared with the agreement between untrained operators ( 0.47). Therefore, the Doppler sonography protocol requires appropriate training before it can be applied.
Yes, it is important to standardize imaging techniques for CCSVI---but isn't it also important to note that pwMS have these specific venous abnormalities? Many neurologists have been saying that "Dr. Zivadinov isn't finding CCSVI....he doesn't believe in it. The Buffalo studies are negative."
But that's simply not true. This is a positive study finding jugular venous malformations in pwMS....that's not including the azygos vein, Ignore the title of the paper and read the research for yourself. CCSVI is real.