Probably one of many for the new year that casts doubt on the validity of CCSVI specificy for MS.
However, is it that we can not find CSSVI because we are not doing properly?
Zamboni P, Morovic S, Menegatti E, Viselner G, Nicolaides AN. Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound - Recommendations for a protocol. Int Angiol. 2011;30:571-97.
Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses or obstructions of the internal jugular and/or azygos veins with disturbed flow and formation of collateral venous channels.
Studies using ultrasound in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 70%; range 0-100%; N.=1496), whereas, in normal controls and patients without MS the prevalence was much lower (mean 10%; range 0-36%; N.=635).
Ultrasound uses a combination of physiological measurements as well as anatomical imaging and has been used for the detection of CCSVI by different centers with variable results. A high occurance ranging from 62% to 100% of obstructive lesions has been found by some teams in patients with MS compared with a lower occurence (prevalence) of 0-25% in controls. However, absence of such lesions or a lower prevalence (16-52%) has been reported by others.
This variability could be the result of differences in technique, training, experience or criteria used. The current lack of a methodology shared among experts is a confounding element in epidemiologic studies, and does not permit further analysis. In order to ensure a high reproducibility of Duplex scanning with comparable accuracy between centers, a detailed protocol with standard methodology and criteria is proposed and proposes a reporting standard of Duplex measurements and future research to answer areas of uncertainty.
This field needs a standardised protocol to see what the true occurence of CCSVI is. This should have been available very quickly to limit all ambiguity in the deluge of pages that will be appearring.
I think I'll save them up and post occassionally, unless there is something earth shattering, rather than doing this as they arrive.
Labels: CCSVI