CCSVI Screening

By: AIM Medical Imaging - MRI Centre  17-08-2010
Keywords: Medical Clinic, Patient Care, Mri


Chronic Cerebrospinal Venous Insufficiency (CCSVI) remains a research based cause for Multiple Sclerosis (MS). At AIM we perform a complete contrast enhanced 'traditional' MS MRI study of the brain and cervical cord in addition to CCSVI research protocol. Currently in the medical literature, the cause and effect of CCVSI and MS remains uncertain. At AIM, we use the research based Siemen's MRI protocol developed by Dr. Mark Haake to ensure consistency of MRI data analysis which includes SWI and Flow Quantification. Dr. Haacke's imaging protocol can be found at SWI, a Siemens MRI sequence developed by Dr. Haake, is able to accurately determine iron or other heavy metal deposits in the brain. Researchers suspect iron build up occurs secondary to blocked or narrowed veins in the head or neck in MS patients. SWI is the only way to accurately visualize these iron deposits. CCSVI is based on the hypothesis of an outflow (venous) irregularity in the head or neck. A blockage or reversed flow in a draining vein will cause a cerebrospinal vein flow rate change. The flow of the veins within the head can only be shown with Flow Quantification MRI or with Transcranial Ultrasound. Flow Quantification MRI is able to determine which veins exhibit reduced or reversed flow. We assess the venous flow in multiple areas; including the upper and lower parts of both jugular veins, both transverse sinuses, the superior sagittal sinus and the straight sinus of the brain and/or regions demonstrating vascular narrowing. By assessing all of these structures, accurate blood flow results are obtained. Dr. Haacke recommends Flow Quantification MRI be performed as part of his imaging guidelines. There is also debate as to whether transcranial ultrasound can obtain similar results. Ultrasound is limited by being highly "user dependent" and regular ultrasound cannot "see" through bone. Flow quantification MRI does not have this problem. In fact, it is equally easy to view the veins inside or outside the skull, neck or chest with Flow Quantification MRI. A Transcranial Ultrasound machine has been developed to be able to see veins through the skull. As of July 1, 2010 there are no facilities in Vancouver with a transcranial ultrasound machine. A regular ultrasound will only be able to give information of the jugular veins in the neck after they exit the skull. A definite diagnosis about CCSVI is ideally determined at Venography with pressure data. Research into this field is limited and imaging is still in its preliminary stages. AIM and the current medical literature do not support intervention based on the limited data available for CCSVI and its relation to MS.

Keywords: Healthcare Imaging, Magnetic Resonance Imaging, Medical Clinic, Mri, Patient Care

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