ISNVD Abstract Book

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Bruxism and Temporal Bone Hypermobility in Patients with Multiple Sclerosis David E. Williams Introduction: Many of the disease elements of MS are similar to those of long term cranial trauma. Anatomical observations by the principle author have suggested that one possible source of trauma could be instigated by bruxism via cranial suture insufficiency. In this study, the authors investigated the link between jaw clenching/bruxism and temporal bone movement associated with multiple sclerosis (MS). Materials and Methods: Twenty-one subjects participated in this study (10 patients with MS and 11 controls). To quantify the change in intracranial dimension between the endocranial surfaces of the temporal bones during jaw clenching, an ultrasonic pulsed phase locked loop (PPLL) device was used. A sustained jaw clenching force of 100 lbs was used to measure the mean change in acoustic pathlength (_L) as the measure of intracranial distance. Results: In the control subjects the mean _L was 0.27 mm±0.24. In ubjects with MS the mean _L was 1.71 mm±1.18 (p
GeneralMagneticResonanceImaging(MRI)ProtocolfortheStudyofChronicCerebrospinalVenous Insufficiency(CCSVI)inMultipleSclerosisPatients TheMRICCSVIProtocolusesaconventionalneuroimagingprotocolforMSwithadditionalspecialized sequencestostudythevasculatureinthebrain,neckandspineaswellastheironcontentinthebrain. Onthevascularside,bothanatomicandflowinformationiscollected.AmajorbenefitofusingMRIis thatitprovidestheneurologistwithwhatheneedsforassessingMS,itprovidestheinterventionalist3D planninganditprovidesallpartieswithcriticalflowinformationwhichmaywellbecomeakeymarker fordecidingwhenorwhennottotreatapatient.MRIisalsooperatorindependentforthemostpart andthesameprotocolscanberunonmostmanufacturers’systems.Thedataarealsoeasilyreproduced when run on the same equipment from site to site.Potential biomarkers for CCSVI and MS can be identifiedfromthedata.MRIcanalsolongitudinallytracktheprogressofthe diseaseovertimevia lesioncountsandtype,physiologicchangeslikebloodflowandcerebrospinalfluid(CSF)dynamics,and provideabaselineforfuturescans. Thefollowingimagingprotocolispresentedfora3TeslaSiemensScannerbutcanbeextendedtoother field strengths and manufacturers.The scans proposed are: 2D time of flight MR venography (TOF MRV), timeresolved contrast enhanced 3D MR angiography and venography (MRAV), 3D volumetric interpolatedbreathholdexamination(VIBE),phasecontrastflowdataatdifferentlevelsintheneckand thoracic cavity, as well as the conventional T2 weighted imaging (WI), T2 fluid attenuated inversion recovery(FLAIR),susceptibilityweightedimaging(SWI),andpreandpostcontrastT1weightedimaging (WI)ormagnetizationpreparedrapidgradientecho(MPRAGE)imaging.Perfusionscanningcanalsobe addedintothisprotocolforasmallincrementintime(roughly3minutesextra). 2DTOFMRVscansareusedtodetectbloodflowinarteriesandveins.Usingasaturationband,anyflow towardthehead(arterialflow)willbesaturated,andtheflowtowardstheheart(venousflow)willbe highlightedinavelocitydependentmanner.Fromthissequence,veinsarewellvisualizedanditcanbe determinediftheyarepatent,occluded,orstenosed.Sincethedataarecollectedwithhighresolution, vesselcrosssectioncanalsobecalculatedtoevaluatethedegreeofstenosis. 3DCEMRAVcanalsobeusedtoevaluatevascularabnormalities.ThescanusesaT1reducingcontrast agentwhichpassesthroughallvesselsandleadstoincreasedsignalforvesselsinT1weightedscans. Fromthedata,3Danatomicalassessmentscanbedonetoevaluatevesselpatency.Atresias,aplasias, truncularmalformations,valveissues,andstenosescanbedetected. 3D VIBE pre and postcontrast can be used to evaluate structural patency of vessels as well as inhomogeneousenhancementofthetissue.Itisanalternateapproachtothe3DdynamicCEapproach justdiscussedandtakesmuchlonger(althoughstillrelativelyfast). 2DPCMRIimagesareusedtoassessflowdynamicsintheheadandneckveinsandarteries,theazygous vein,andCSFattheC2cervicallevel.Thisinformationisvaluablebecauseitcanbothcorroborateand complimenttheinformationseeninthe2DTOFMRVand3DCEMRAV.Itisnotuncommontovisualize themajorveinsonlylatertofindthatmanyoftheveinshavecompromisedbloodflow. Susceptibility Weighted Imaging (SWI) is useful because the image contrast is based on the intrinsic susceptibilitiesoftissues.Forexample,veinsarerichindeoxyhemoglobinwhichisparamagneticand providesclearvisibilityofvenousstructures.Quantificationofironinthegraymatteraswellaslesions canbeaccomplishedusingT2*,phaseorsusceptibilitymappingfromthephaseimages.SWIisalso
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The 2 nd Annual ISNVD Scientific Me
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PRINCIPLE CONSIDERATIONS ON VENOUS
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using several methods. These method
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Page 55 and 56: POSTER ABSTRACTS Monday, February 2
Page 57 and 58: POLITECNICO DI MILANO mlagana@dongn
Page 60 and 61: Background Iron deposition in clini
Page 62 and 63: Short-Term Outcomes After Endovascu
Page 64 and 65: Internal jugular vein valve morphol
Page 66 and 67: The Cerebral Perfusion of Patients
Page 68 and 69: Intravascular Ultrasound for detect
Page 70 and 71: Prevalence of Chronic Cerebrospinal
Page 72 and 73: Azygos compression and effect of re
Page 74 and 75: Iron deposition in pediatric multip
Page 76 and 77: Q Q Q Q Simple mathematical model f
Page 78 and 79: Introduction Cardiac Effects In The
Page 80 and 81: Acetazolamide as a medical treatmen
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Page 85 and 86: Physician Documentation of Fluorosc
Page 87 and 88: Characteristics of patients who mai
Page 89 and 90: FINDINGS ON VENOGRAPHY IN MS PATIEN
Page 91: Does metal-induced hypersensitivity
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Page 97 and 98: Magnetic Resonance Imaging (MRI) Tr
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