Dr. Brenda Banwell, The Hospital for Sick Children, Toronto, Ontario: To determine whether signs of impaired vein drainage might be present early in the MS disease course, Dr. Banwell’s team received approval from the Research Ethics Board and began enrolling children and teenagers who have MS, and healthy controls of the same age. They are seeking venous abnormalities using non-invasive MRI measures of vein anatomy and novel measures of venous flow, as well as ultrasound. Unlike adults with MS, children are unlikely to have age-related changes in blood vessels, and are less likely to have adult health conditions such as high blood pressure or heart disease, which might otherwise complicate findings. The researchers’ ultrasound team received training in Dr. Zamboni’s original techniques from the Buffalo Neuroimaging Analysis Center; the team has created ultrasound and brain imaging procedures suited to explore venous drainage in children. Dr. Banwell’s team reports that recruitment is going well and plans to analyze findings only after all 90 participants have undergone the testing. Dr. Fiona Costello, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta: Once it received Research Ethics Board approval, Dr. Costello’s team began recruiting a cross-section of people with MS who would be compared with those affected by other neurological diseases or healthy volunteers. They have three dedicated ultrasound technologists who have been trained to do scanning as originally done by Dr. Zamboni and they have refined their scanning protocol. The team is planning to repeat scans on a subset of participants who had been scanned before they made method changes, which will allow them to compare the sensitivity of results pre- and post-training. Dr. Costello’s team slowed recruitment briefly to upgrade to a new 3 Tesla (3T) MRI scanner, twice as strong as standard clinical MRI, and they have expanded their MRI team to include two additional, experienced members. The 3T machine went online in March 2011 and is now being used to perform MR
venography scans to compare against the ultrasound tests. Dr. Aaron Field, University of Wisconsin School of Medicine and Public Health, Madison: His team is actively recruiting participants to undergo MR venography and ultrasound techniques to investigate CCSVI in people with early and later stages of MS, controls with other conditions and healthy volunteers, now that they have received approval of the study from the Institutional Review Board (IRB). The team has refined its MR venography protocol to account for variations in blood flow that occur with breathing and heartbeats. They have determined that they will use a relatively new contrast agent or dye that will permit high-quality images of the veins in the head and neck and for measuring blood flow in the brain. This will enable the entire MRI/MRV exam to be completed with one timesaving injection instead of two. They have also standardized locations along the length of veins where they take blood flow measurements because they have found large differences in both anatomy and size of head and neck veins. Dr. Robert Fox, Cleveland Clinic Foundation, Cleveland: After his team received IRB approval for using MR venography, ultrasound, MRI and clinical measures in people with MS or who are at risk for MS (CIS) and comparison groups, they began recruiting and scanning participants. The ultrasound team found several aspects of the published methodology ambiguous; the team has standardized protocol and analysis to achieve consistent results. They shared their solutions to these methodological challenges in a poster presented at the American Academy of Neurology’s annual meeting in April 2011. The poster outlined physiological and technical factors that can complicate screening for vein blockages using ultrasound, including that heartbeat irregularities, stages of breathing, head Moving Toward A World Free of MS
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