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Central venous pressure estimation with force-coupled ultrasound of the internal jugular vein. Sci Rep 2023; 13:1500. [PMID: 36707658 PMCID: PMC9883282 DOI: 10.1038/s41598-022-22867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/20/2022] [Indexed: 01/29/2023] Open
Abstract
We estimate central venous pressure (CVP) with force-coupled ultrasound imaging of the internal jugular vein (IJV). We acquire ultrasound images while measuring force applied over the IJV by the ultrasound probe imaging surface. We record collapse force, the force required to completely occlude the vein, in 27 healthy subjects. We find supine collapse force and jugular venous pulsation height (JVP), the clinical noninvasive standard, have a linear correlation coefficient of r2 = 0.89 and an average absolute difference of 0.23 mmHg when estimating CVP. We perturb our estimate negatively by tilting 16 degrees above supine and observe decreases in collapse force for every subject which are predictable from our CVP estimates. We perturb venous pressure positively to values experienced in decompensated heart failure by having subjects perform the Valsalva maneuver while the IJV is being collapsed and observe an increase in collapse force for every subject. Finally, we derive a CVP waveform with an inverse three-dimensional finite element optimization that uses supine collapse force and segmented force-coupled ultrasound data at approximately constant force.
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Nakano H, Hashimoto H, Mochizuki M, Naraba H, Takahashi Y, Sonoo T, Nakamura K. Evaluation of Intravascular Volume Using the Internal Jugular Vein Cardiac Collapse Index in the Emergency Department: A Preliminary Prospective Observational Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1169-1178. [PMID: 35370023 DOI: 10.1016/j.ultrasmedbio.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/17/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
A non-invasive method for assessment of intravascular volume for optimal fluid administration is needed. We here conducted a preliminary study to confirm whether cardiac variation in the internal jugular vein (IJV), evaluated by ultrasound, predicts fluid responsiveness in patients in the emergency department. Patients who presented to the emergency department between August 2019 and March 2020 and required infusions were enrolled. We recorded a short-axis video of the IJV, respiratory variability in the inferior vena cava and stroke volume variations using the ClearSight System (Edwards Lifesciences, Irvine, CA, USA) before infusion of 500 mL of crystalloid fluid. Cardiac variations in the cross-sectional area of the IJV were measured by speckle tracking. Among the 148 patients enrolled, 105 were included in the final analysis. Fluid responsiveness did not correlate with the cardiac collapse index (13.6% vs. 16.8%, p = 0.24), but correlated with stroke volume variations (12.5% vs. 15.6%, p = 0.026). Although it is a simple correction, the cardiac collapse index correlated with stroke volume corrected by age (r = 0.25, p = 0.01), body surface area (r = 0.33, p = 0.002) and both (r = 0.35, p = 0.001). Cardiac variations in the IJV did not predict fluid responsiveness in the emergency department, but may reflect stroke volume.
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Affiliation(s)
- Hidehiko Nakano
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan.
| | - Hideki Hashimoto
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Masaki Mochizuki
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Hiromu Naraba
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Yuji Takahashi
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Tomohiro Sonoo
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
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Patient-specific computational fluid dynamic simulation of cerebrospinal fluid flow in the intracranial space. Brain Res 2022; 1790:147962. [DOI: 10.1016/j.brainres.2022.147962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
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4
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İlhan Z, Açıkgözoğlu S, Demir O. Associations Between Doppler Internal Jugular Vein Blood Flow and Transverse Sinus Stasis Detected by Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1591-1601. [PMID: 33085792 DOI: 10.1002/jum.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/12/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study aimed to compare the estimated internal jugular vein (IJV) volume flow with Doppler ultrasound in patients with slow flow in the transverse sinuses and normal transverse sinuses on brain magnetic resonance imaging (MRI). METHODS Eighty patients between the ages of 18 and 80 years who did not have any signs of sinus vein thrombosis on brain MRI were included. On MRI, cases with hyperintensity due to a signal void loss in the transverse sinuses in coronal fluid attenuation inversion recovery sequences were included in the slow-flow group. The presence of sinus thrombosis was excluded with other MRI pulse sequences and clinical findings. The participants were divided into 2 groups as having normal and slow flow according to MRI findings. Then bilateral IJV volume flow measurements were made by Doppler ultrasound. Bilateral volume flow was estimated by time-averaged blood flow velocities sampled in the center of the IJV, and IJV cross-sectional areas were measured. We defined the dominant IJV as the one having the higher estimated volume flow of the 2 sides. RESULTS Total estimated IJV blood flow was lower (P < .001) in patients with slow flow on MRI (546 mL/min) compared to those without (768 mL/min). A similar finding was seen for the nondominant IJV. In a receiver operating characteristic analysis, the cutoff value for the total estimated IJV volume flow was determined to be 590 mL/min, and the cutoff value for nondominant estimated IJV volume flow was determined to be 202 mL/min to distinguish between the groups. CONCLUSIONS Low estimated volume blood flow in the IJV is associated with MRI evidence of stasis in the ipsilateral transverse sinus.
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Affiliation(s)
- Zeki İlhan
- Departments of Radiology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey
| | - Saim Açıkgözoğlu
- Departments of Radiology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey
| | - Orhan Demir
- Departments of Neurology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey
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Beggs C, Tavoni V, Menegatti E, Tessari M, Ragazzi R, Malagoni AM, Giovanardi L. Spectral characteristics of the internal jugular vein and central venous pressure pulses: a proof of concept study. VEINS AND LYMPHATICS 2021. [DOI: 10.4081/vl.2021.9732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this proof-of-concept study the impact of central venous pressure (CVP) on internal jugular veins cross-sectional area (CSA) and blood flow time-average velocity (TAV) was evaluated in eight subjects, with the aim of understanding the drivers of the jugular venous pulse. CVP was measured using a central venous catheter while CSA variation and TAV along a cardiac cycle were acquired using ultrasound. Analysis of CVP, CSA and TAV time-series signals revealed TAV and CSA to lag behind CVP by on average 0.129 s and 0.138 s, with an inverse correlation between CSA and TAV (r= –0.316). The respective autocorrelation signals were strongly correlated (mean r=0.729-0.764), with mean CSA periodicity being 1.062 Hz. Fourier analysis revealed the frequency spectrums of CVP, TAV and CSA signals to be dominated by frequencies at approximately 1 and 2 Hz, with those >1 Hz greatly attenuated in the CSA signal. Because the autocorrelograms and periodograms of the respective signals were aligned and dominated by the same underlying frequencies, this suggested that they are more easily interpreted in the frequency domain rather than the time domain.
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Zamboni P, Malagoni AM, Menegatti E, Ragazzi R, Tavoni V, Tessari M, Beggs CB. Central venous pressure estimation from ultrasound assessment of the jugular venous pulse. PLoS One 2020; 15:e0240057. [PMID: 33112871 PMCID: PMC7592775 DOI: 10.1371/journal.pone.0240057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/17/2020] [Indexed: 01/21/2023] Open
Abstract
Objectives Acquiring central venous pressure (CVP), an important clinical parameter, requires an invasive procedure, which poses risk to patients. The aim of the study was to develop a non-invasive methodology for determining mean-CVP from ultrasound assessment of the jugular venous pulse. Methods In thirty-four adult patients (age = 60 ± 12 years; 10 males), CVP was measured using a central venous catheter, with internal jugular vein (IJV) cross-sectional area (CSA) variation along the cardiac beat acquired using ultrasound. The resultant CVP and IJV-CSA signals were synchronized with electrocardiogram (ECG) signals acquired from the patients. Autocorrelation signals were derived from the IJV-CSA signals using algorithms in R (open-source statistical software). The correlation r-values for successive lag intervals were extracted and used to build a linear regression model in which mean-CVP was the response variable and the lagging autocorrelation r-values and mean IJV-CSA, were the predictor variables. The optimum model was identified using the minimum AIC value and validated using 10-fold cross-validation. Results While the CVP and IJV-CSA signals were poorly correlated (mean r = -0.018, SD = 0.357) due to the IJV-CSA signal lagging behind the CVP signal, their autocorrelation counterparts were highly positively correlated (mean r = 0.725, SD = 0.215). Using the lagging autocorrelation r-values as predictors, mean-CVP was predicted with reasonable accuracy (r2 = 0.612), with a mean-absolute-error of 1.455 cmH2O, which rose to 2.436 cmH2O when cross-validation was performed. Conclusions Mean-CVP can be estimated non-invasively by using the lagged autocorrelation r-values of the IJV-CSA signal. This new methodology may have considerable potential as a clinical monitoring and diagnostic tool.
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Affiliation(s)
- Paolo Zamboni
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Anna Maria Malagoni
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Erica Menegatti
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Valentina Tavoni
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Mirko Tessari
- HUB Center Regione Emilia Romagna for Venous and Lymphatics Disorders, University Hospital of Ferrara, Ferrara, Italy
| | - Clive B. Beggs
- Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
- * E-mail:
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Mohammed NY, Di Domenico G, Menegatti E, Sisini F, Vannini ME, Gambaccini M, Tessari M, Zamboni P. Mechanical Function of Internal Jugular Vein Valve: Post-analysis of M-Mode Imaging under Cardiac Monitoring. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3087-3101. [PMID: 31540759 DOI: 10.1016/j.ultrasmedbio.2019.06.418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 05/31/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
Because the internal jugular vein (IJV) valve is the only protective valve between the brain and heart, recent studies have focused on the dynamic behaviour of the valve and its importance in regulating the cerebral blood outflow pathway. However, the mechanism underlying valve opening and closure, as well as the normal opening time, has not been investigated before. The aim of the study described here was to investigate IJV physiology in healthy young adults by means of ultrasound imaging. Twenty-four normal young adults (16 male, 8 female, 21.79 ± 0.79 y of age) were enrolled in this study. Each participant underwent IJV B- and M-mode ultrasound scans of the neck veins in supine position. Data on IJV leaflet movement and IJV blood velocity were extracted from images with the associated electrocardiogram traces to analyze the opening and closure cycles of IJV leaflets. The normal opening time calculated in this study includes 70% of the dynamic valve cycle. The normal opening time of the IJV valve could be a new physiologic metric and serves as a premise for further studies in the field of cerebral venous return.
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Affiliation(s)
- Nadiya Y Mohammed
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Di Domenico
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy.
| | - Erica Menegatti
- Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
| | - Francesco Sisini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Elena Vannini
- Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
| | - Mauro Gambaccini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Mirko Tessari
- Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy
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De Bonis P, Menegatti E, Cavallo MA, Sisini F, Trapella G, Scerrati A, Zamboni P. JEDI (jugular entrapment, dilated ventricles, intracranial hypertension) syndrome: a new clinical entity? A case report. Acta Neurochir (Wien) 2019; 161:1367-1370. [PMID: 31025176 DOI: 10.1007/s00701-019-03908-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
Patients with idiopathic intracranial hypertension are frequently obese women with normal/slit ventricles. Patients with high-pressure hydrocephalus, instead, present enlarged ventricles. We describe a 63-year-old woman with signs and symptoms of intracranial hypertension. Brain MRI revealed hydrocephalus. Venous Doppler ultrasound showed external compression of the omohyoid muscles on the internal jugular veins. During jugular vein decompression, intracranial pressure dropped from 18 to 6 mmHg. Patient is asymptomatic at 2-year follow-up, with decreased brain ventricles. These findings could represent a novel form of high-pressure hydrocephalus that can be successfully treated without a CSF shunt. We called this syndrome JEDI (jugular entrapment dilated ventricles intracranial hypertension).
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Marr K, Jakimovski D, Mancini M, Carl E, Zivadinov R. Jugular Venous Flow Quantification Using Doppler Sonography. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1762-1769. [PMID: 29784437 PMCID: PMC6026550 DOI: 10.1016/j.ultrasmedbio.2018.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/30/2018] [Accepted: 04/15/2018] [Indexed: 06/08/2023]
Abstract
A consensus on venous flow quantification using echo spectral Doppler sonography is lacking. Doppler sonography data from 83 healthy individuals were examined using manually traced transverse cross-sectional area and diameter-derived cross-sectional area obtained in longitudinal view measurements of the internal jugular vein. Time-averaged velocity over a 4-s interval was obtained in the longitudinal plane using manual tracing of the waveform. Manual and computer-generated blood flow volume calculations were also obtained for the common carotid artery, for accuracy purposes. No differences were detected between semi-automated and manual blood flow volume calculations for the common carotid artery. The manual calculation method resulted in almost twofold larger venous internal jugular vein flow measurements compared with the semi-automated method. Doppler sonography equipment does not provide accurate automated calculation of venous size and blood flow. Until further technological development occurs, manual calculation of venous blood flow is warranted.
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Affiliation(s)
- Karen Marr
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Rome, Italy
| | - Ellen Carl
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, New York, USA.
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10
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Zamboni P, Sisini F, Menegatti E, Taibi A, Gadda G, Tavoni V, Malagoni AM, Tessari M, Gianesini S, Gambaccini M. Ultrasound Monitoring of Jugular Venous Pulse during Space Missions: Proof of Concept. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:726-733. [PMID: 29276139 DOI: 10.1016/j.ultrasmedbio.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/27/2017] [Accepted: 11/04/2017] [Indexed: 06/07/2023]
Abstract
The jugular venous pulse (JVP) is one of the main parameters of cardiac function and is used by cardiologists in diagnosing heart failure. Its waveform comprises three positive waves (a, c and v) and two negative waves (x and y). Recently, it was found that JVP can be extrapolated from an ultrasound (US) video recording of the internal jugular vein (IJV), suggesting its application in space missions, on which US scanners are already widely used. To date, the feasibility of assessing JVP in microgravity (microG) has not been investigated. To verify the feasibility of JVP assessment in microG, we tested a protocol of self-performed B-mode ultrasound on the International Space Station (ISS). The protocol consisted of a video recording of IJV synchronized with electrocardiogram that produces a cross-sectional area time trace (JVP trace) (in cm2). The scans were acquired in six experimental sessions; two pre-flight (BDC1 and -2), two in space (ISS1 and -2) and two post-flight (Houston PF1, Cologne PF2). We measured the mean and standard deviation of the JVP waves and the phase relationship between such waves and P and T waves on the electrocardiogram. We verified that such parameters had the same accuracy on Earth as they did under microG, and we compared their values. The sensitivity, specificity and accuracy of JVP trace in microgravity are higher than those on Earth. The sequence of (a, c, and v) ascents and (x and y) descents along the cardiac cycle in microG is the same as that on Earth. The cause-and-effect relationship between the P and T waves on the electrocardiogram and a and v waves, respectively, of JVP is also confirmed in microG. Our experiment indicated the feasibility of deriving a JVP trace from a B-mode US examination self-performed by an astronaut in microG.
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Affiliation(s)
- Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Cona, Ferrara, Italy
| | - Francesco Sisini
- Vascular Diseases Center, University of Ferrara, Cona, Ferrara, Italy; Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy.
| | - Erica Menegatti
- Vascular Diseases Center, University of Ferrara, Cona, Ferrara, Italy
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Giacomo Gadda
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Valentina Tavoni
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | | | - Mirko Tessari
- Vascular Diseases Center, University of Ferrara, Cona, Ferrara, Italy
| | - Sergio Gianesini
- Vascular Diseases Center, University of Ferrara, Cona, Ferrara, Italy
| | - Mauro Gambaccini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
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Nakamura K. Reply: Novel Interest About Cardiac Variation of Internal Jugular Vein for the Evaluation of the Hemodynamics. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:380-381. [PMID: 27720523 DOI: 10.1016/j.ultrasmedbio.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan.
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12
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Sisini F, Taibi A, Gambaccini M, Zamboni P. Novel Interest About Cardiac Variation of Internal Jugular Vein for the Evaluation of the Hemodynamics. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:380. [PMID: 27720518 DOI: 10.1016/j.ultrasmedbio.2016.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Francesco Sisini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy; Vascular Diseases Center, University of Ferrara, Ferrara, Italy.
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Mauro Gambaccini
- Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
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13
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Ogoh S, Washio T, Sasaki H, Petersen LG, Secher NH, Sato K. Coupling between arterial and venous cerebral blood flow during postural change. Am J Physiol Regul Integr Comp Physiol 2016; 311:R1255-R1261. [DOI: 10.1152/ajpregu.00325.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 11/22/2022]
Abstract
In supine humans the main drainage from the brain is through the internal jugular vein (IJV), but the vertebral veins (VV) become important during orthostatic stress because the IJV is partially collapsed. To identify the effect of this shift in venous drainage from the brain on the cerebral circulation, this study addressed both arterial and venous flow responses in the “anterior” and “posterior” parts of the brain when nine healthy subjects (5 men) were seated and flow was manipulated by hyperventilation and inhalation of 6% carbon dioxide (CO2). From a supine to a seated position, both internal carotid artery (ICA) and IJV blood flow decreased ( P = 0.004 and P = 0.002), while vertebral artery (VA) flow did not change ( P = 0.348) and VV flow increased ( P = 0.024). In both supine and seated positions the ICA response to manipulation of end-tidal CO2 tension was reflected in IJV ( r = 0.645 and r = 0.790, P < 0.001) and VV blood flow ( r = 0.771 and r = 0.828, P < 0.001). When seated, the decrease in ICA blood flow did not affect venous outflow, but the decrease in IJV blood flow was associated with the increase in VV blood flow ( r = 0.479, P = 0.044). In addition, the increase in VV blood flow when seated was reflected in VA blood flow ( r = 0.649, P = 0.004), and the two flows were coupled during manipulation of the end-tidal CO2 tension (supine, r = 0.551, P = 0.004; seated, r = 0.612, P < 0001). These results support that VV compensates for the reduction in IJV blood flow when seated and that VV may influence VA blood flow.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe, Japan
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe, Japan
| | - Hiroyuki Sasaki
- Department of Biomedical Engineering, Toyo University, Kawagoe, Japan
| | - Lonnie G. Petersen
- The Copenhagen Muscle Research Center, Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels H. Secher
- The Copenhagen Muscle Research Center, Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kohei Sato
- Research Institute of Physical Fitness, Japan Women’s College of Physical Education, Tokyo, Japan; and
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14
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Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse. Behav Neurol 2016; 2016:7082856. [PMID: 27006525 PMCID: PMC4783538 DOI: 10.1155/2016/7082856] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/24/2015] [Accepted: 02/01/2016] [Indexed: 12/28/2022] Open
Abstract
Assessment of cerebral venous return is growing interest for potential application in clinical practice. Doppler ultrasound (DUS) was used as a screening tool. However, three meta-analyses of qualitative DUS protocol demonstrate a big heterogeneity among studies. In an attempt to improve accuracy, several authors alternatively measured the flow rate, based on the product of the time average velocity with the cross-sectional area (CSA). However, also the quantification protocols lacked of the necessary accuracy. The reasons are as follows: (a) automatic measurement of the CSA assimilates the jugular to a circle, while it is elliptical; (b) the use of just a single CSA value in a pulsatile vessel is inaccurate; (c) time average velocity assessment can be applied only in laminar flow. Finally, the tutorial describes alternative ultrasound calculation of flow based on the Womersley method, which takes into account the variation of the jugular CSA overtime. In the near future, it will be possible to synchronize the electrocardiogram with the brain inflow (carotid distension wave) and with the outflow (jugular venous pulse) in order to nicely have a noninvasive ultrasound picture of the brain-heart axis. US jugular venous pulse may have potential use in neurovascular, neurocognitive, neurosensorial, and neurodegenerative disorders.
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