But the thing is, there hasn't been a single study that has demonstrated a "position variable craniocervical relationship." We aren't beyond the phase of needing basic studies that show stuff like Clivo axial angle , etc. We still need studies that establish the most basic structural problems and whether they exist with ME/CFS at all.
Agree. If it were shown to be even modestly common, that would be a very important clue. We would still want to try and understand the mechanism better. If we knew the mechanism it might indicate a common factor with affected patients who do not have CCI. Also, for those patients with CCI, understanding the mechanism might lead to a more simple treatment, that does not require the extreme of surgical fusion.
Also while there are many benefits to higher resolution mris to truly show blood flow changes I'd think youd want an fmri.
Apologies if I misunderstand your point. fMRI refers to the technique, not the machine. A higher field strength machine can produce higher spatial/contrast resolution imaging (or same resolution, faster). The blood flow changes that represent the brain functions under evaluation in fMRI will be demonstrated: at all / better / 'fully' at higher field strength.
Except they said its specifically to look for whether cci exists in an ME/CFS cohort.
From the Polybio website: "With our planned sequences we can, in a reliable and replicable fashion, detect a range of potential symptom mechanisms such as structural abnormalities (e.g., CCI), autonomic dysfunction, cerebrospinal fluid flow problems, brain blood flow issues, intracranial pressure evidence, and metabolic impairment."
This suggests structural abnormalities (CCI) are just one aspect of their evaluation, but they want uniformity of imaging evaluation. They would seriously compromise evaluation of all other aspects if they were compelled to use low-field upright MRI.
I mean people even do x Ray's or fluoroscopy which are far lowerresolution, while upright , to show these issues, bc dynamic imaging and showing the effects of gravity on the problem is more important than high resolution.
Radiographs have the highest spatial resolution in medical imaging (but modest contrast resolution). X-rays and dynamic fluoroscopy are good methods to image the patient in any position, including standing. Possibly, a good study to evaluate the incidence of CCI in ME/CFS patients would actually use standing dynamic radiographs/fluoroscopy.
CT and MRI can complement these imaging techniques and while lower in spatial resolution, have high contrast resolution. The problem is that CT and MRI are very limited for upright imaging, with our current technology, so won't show what they want to see. Additionally, it is harder for the patient to keep still while standing than lying down. (In)voluntary and respiratory motion are the enemy of MR imaging and would negate the high field benefits.
I'm sure Michael and his team would love to be using an 11T upright MRI for CCI evaluation!
