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Dai C, Zhao P, Ding H, Lv H, Qiu X, Tang R, Xu N, Huang Y, Han X, Yang Z, Wang Z. Cerebral Sinus Hemodynamics in Adults Revealed by 4D Flow MRI. J Magn Reson Imaging 2024. [PMID: 38235948 DOI: 10.1002/jmri.29210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The hemodynamics of the cerebral sinuses play a vital role in understanding blood flow-related diseases, yet the hemodynamics of the cerebral sinuses in normal adults remains an unresolved issue. PURPOSE To evaluate hemodynamics in the cerebral sinus of adults using 4-dimensional flow MRI (4D Flow MRI). STUDY TYPE Cross-sectional. POPULATION Ninety-nine healthy volunteers (mean age, 42.88 ± 13.16 years old; females/males, 55/44). FIELD STRENGTH/SEQUENCE 3 T/4D Flow MRI. ASSESSMENT The blood flow velocity, average blood flow rate (Q), and vortexes at the superior sagittal sinus (SSS), straight sinus (STS), transverse sinus, sigmoid sinus, and jugular bulb of each volunteer were evaluated by two independent neuroradiologists. The relationship between the total cerebral Q and sex and age was also assessed. Twelve volunteers underwent two scans within a month. STATISTICAL TESTS The intraclass correlation coefficient (ICC) evaluated the inter-observer agreement. Blood flow parameters among volunteers were compared by the independent-sample t-test or Mann-Whitney U test. The multiple linear regression equation was used to evaluate the relationship between total cerebral Q and age and sex. P < 0.05 indicated statistical significance. RESULTS The test-retest and interobserver reliability of average velocity and Q were moderate to high (ICC: 0.54-0.99). Cerebral sinus velocity varied by segment and cardiac cycle. The SSS's velocity and Q increased downstream and Q near torcular herophili was 3.5 times that through the STS. The total cerebral Q decreased by 0.06 mL/s per year (β = -0.06 ± 0.013) and was sex-independent within the group. Vortexes were found in 12.12%, 8.9%, and 59.8% of torcular herophili, transverse-sigmoid junction, and jugular bulb, respectively, and were related to higher upstream flow. DATA CONCLUSION Cerebral sinuses could be measured visually and quantitatively in vivo by 4D Flow MRI, providing a basis for future research on pulsating tinnitus, multiple sclerosis, and other related diseases. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Chihang Dai
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Qiu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ruowei Tang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ning Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yan Huang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xu Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Sarrami AH, Bass DI, Rutman AM, Alexander MD, Aksakal M, Zhu C, Levitt MR, Mossa-Basha M. Idiopathic intracranial hypertension imaging approaches and the implications in patient management. Br J Radiol 2022; 95:20220136. [PMID: 35522777 PMCID: PMC10162046 DOI: 10.1259/bjr.20220136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) represents a clinical disease entity without a clear etiology, that if left untreated, can result in severe outcomes, including permanent vision loss. For this reason, early diagnosis and treatment is necessary. Historically, the role of cross-sectional imaging has been to rule out secondary or emergent causes of increased intracranial pressure, including tumor, infection, hydrocephalus, or venous thrombosis. MRI and MRV, however, can serve as valuable imaging tools to not only rule out causes for secondary intracranial hypertension but can also detect indirect signs of IIH resultant from increased intracranial pressure, and demonstrate potentially treatable sinus venous stenosis. Digital subtraction venographic imaging also plays a central role in both diagnosis and treatment, providing enhanced anatomic delineation and temporal flow evaluation, quantitative assessment of the pressure gradient across a venous stenosis, treatment guidance, and immediate opportunity for endovascular therapy. In this review, we discuss the multiple modalities for imaging IIH, their limitations, and their contributions to the management of IIH.
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Affiliation(s)
- Amir Hossein Sarrami
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - David I. Bass
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Matthew D Alexander
- Department of Radiology, University of Utah, Salt Lake City, Utah, United States
| | - Mehmet Aksakal
- Department of Radiology, University of Washington, Seattle, United States
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, United States
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Berg RC, Preibisch C, Thomas DL, Shmueli K, Biondetti E. Investigating the effect of flow compensation and quantitative susceptibility mapping method on the accuracy of venous susceptibility measurement. Neuroimage 2021; 240:118399. [PMID: 34273528 DOI: 10.1016/j.neuroimage.2021.118399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/15/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022] Open
Abstract
Quantitative susceptibility mapping (QSM) is a promising non-invasive method for obtaining information relating to oxygen metabolism. However, the optimal acquisition sequence and QSM reconstruction method for reliable venous susceptibility measurements are unknown. Full flow compensation is generally recommended to correct for the influence of venous blood flow, although the effect of flow compensation on the accuracy of venous susceptibility values has not been systematically evaluated. In this study, we investigated the effect of different acquisition sequences, including different flow compensation schemes, and different QSM reconstruction methods on venous susceptibilities. Ten healthy subjects were scanned with five or six distinct QSM sequence designs using monopolar readout gradients and different flow compensation schemes. All data sets were processed using six different QSM pipelines and venous blood susceptibility was evaluated in whole-brain segmentations of the venous vasculature and single veins. The quality of vein segmentations and the accuracy of venous susceptibility values were analyzed and compared between all combinations of sequences and reconstruction methods. The influence of the QSM reconstruction method on average venous susceptibility values was found to be 2.7-11.6 times greater than the influence of the acquisition sequence, including flow compensation. The majority of the investigated QSM reconstruction methods tended to underestimate venous susceptibility values in the vein segmentations that were obtained. In summary, we found that multi-echo gradient-echo acquisition sequences without full flow compensation yielded venous susceptibility values comparable to sequences with full flow compensation. However, the QSM reconstruction method had a great influence on susceptibility values and thus needs to be selected carefully for accurate venous QSM.
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Affiliation(s)
- Ronja C Berg
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Munich, Germany.
| | - Christine Preibisch
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaninger Str. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Clinic for Neurology, Ismaninger Str. 22, 81675 Munich, Munich, Germany.
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom; Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom; Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, United Kingdom.
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom.
| | - Emma Biondetti
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom; Institut du Cerveau - ICM, Centre de NeuroImagerie de Recherche - CENIR, Team "Movement Investigations and Therapeutics" (MOV'IT), INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France.
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Bai C, Wang Z, Stone C, Zhou D, Ding J, Ding Y, Ji X, Meng R. Pathogenesis and Management in Cerebrovenous Outflow Disorders. Aging Dis 2021; 12:203-222. [PMID: 33532137 PMCID: PMC7801276 DOI: 10.14336/ad.2020.0404] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/04/2020] [Indexed: 11/04/2022] Open
Abstract
In keeping with its status as one of the major causes of disability and mortality worldwide, brain damage induced by cerebral arterial disease has been the subject of several decades of scientific investigation, which has resulted in a vastly improved understanding of its pathogenesis. Brain injury mediated by venous etiologies, however, such as cerebral, jugular, and vertebral venous outflow disturbance, have been largely ignored by clinicians. Unfortunately, this inattention is not proportional to the severity of cerebral venous diseases, as the impact they exact on the quality of life of affected patients may be no less than that of arterial diseases. This is evident in disease sequelae such as cerebral venous thrombosis (CVT)-mediated visual impairment, epilepsy, and intracranial hypertension; and the long-term unbearable head noise, tinnitus, headache, dizziness, sleeping disorder, and even severe intracranial hypertension induced by non-thrombotic cerebral venous sinus (CVS) stenosis and/or internal jugular venous (IJV) stenosis. In addition, the vertebral venous system (VVS), a large volume, valveless vascular network that stretches from the brain to the pelvis, provides a conduit for diffuse transmission of tumors, infections, or emboli, with potentially devastating clinical consequences. Moreover, the lack of specific features and focal neurologic signs seen with arterial etiologies render cerebral venous disease prone to both to misdiagnoses and missed diagnoses. It is therefore imperative that awareness be raised, and that as comprehensive an understanding as possible of these issues be cultivated. In this review, we attempt to facilitate these goals by systematically summarizing recent advances in the diagnosis and treatment of these entities, including CVT, CVS stenosis, and IJV stenosis, with the aim of providing a valid, practical reference for clinicians.
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Affiliation(s)
- Chaobo Bai
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongao Wang
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Christopher Stone
- 4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Da Zhou
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiayue Ding
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xunming Ji
- 2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,5Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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Liu S, Liu P, Wang P, Zhang F, Wang L, Wang Y, Lu H, Ma X. Argatroban Increased the Basal Vein Drainage and Improved Outcomes in Acute Paraventricular Ischemic Stroke Patients. Med Sci Monit 2020; 26:e924593. [PMID: 32667287 PMCID: PMC7382300 DOI: 10.12659/msm.924593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Since venous drainage in acute arterial ischemic stroke has not been thoroughly researched, we evaluate the effect of argatroban, a selective direct thrombin inhibitor, as a therapy to increase the rate of basal vein Rosenthal (BVR) drainage and improve patients’ post-stroke outcomes. Material/Methods In this multicenter clinical trial, 60 eligible patients at 4.5 to 48 hours after the stroke onset were recruited. After being randomly allocated into 2 groups, they were treated with standard therapy either alone or with argatroban. Results Compared to the contralateral brain hemisphere, the mean flow velocity (MFV) in BVR drainage was significantly reduced in the stroke-afflicted ipsilateral hemisphere. After treatment with argatroban for 7 days, the MFV from BVR of the ipsilateral hemisphere in the argatroban treated group was significantly increased when compared to the control group. At 90 days after the onset of stroke, the MFV of BVR in the ipsilateral hemisphere was similar in both groups. Compared with controls, the argatroban-treated patients had smaller lesions from baseline to 7 days. Argatroban also improved National Institutes of Health Stroke Scale (NIHSS) scores on day 7 after the onset of stroke. Furthermore, the argatroban group’s neurological functions were superior to those of their untreated counterparts after 90 days. No difference was found in the incidence of adverse reactions between the 2 groups. Conclusions These observations indicate that vein drainage change may contribute to the acute phase of brain edema and the outcomes of ischemic stroke patients. Clinical Trial Registration URL-http://www.chictr.org Unique identifier: ChiCTR-IPR-16008663
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Affiliation(s)
- Shoufeng Liu
- The Graduate School, Tianjin Medical University, Tianjin, China (mainland).,Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Peipei Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Po Wang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China (mainland)
| | - Fang Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Lijun Wang
- Department of Neurology, Tianjin Fourth Central Hospital, Tianjin, China (mainland)
| | - Yu Wang
- Department of Ultrasonography, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Hao Lu
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China (mainland)
| | - Xiaofeng Ma
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China (mainland)
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Zhu X, Liu M, Gong X, Jin Z, Wang F, Wei S, He W. Transcranial Color-Coded Sonography for the Detection of Cerebral Veins and Sinuses and Diagnosis of Cerebral Venous Sinus Thrombosis. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2649-2657. [PMID: 31345650 DOI: 10.1016/j.ultrasmedbio.2019.06.419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to determine the detection rate of transcranial color-coded sonography (TCCS) of cerebral veins and sinuses and to explore the diagnostic accuracy of TCCS for straight sinus (SS) and transverse sinus (TS) thromboses. The detection rates of cerebral veins and sinuses using TCCS and contrast-enhanced TCCS (CE-TCCS) were analyzed. The diagnostic accuracy of CE-TCCS was evaluated. Median time from symptoms to CE-TCCS was 10 (range, 1-150) d. The detection rate of bilateral basal veins of Rosenthal was 100% by CE-TCCS, followed by right TS (91.89%), SS (88.12%), left TS (74.59%) and vein of Galen (70.27%). Compared with magnetic resonance imaging/magnetic resonance venography, CE-TCCS showed 100% sensitivity and 96.3% specificity for SS thrombosis, 100% and 100% for right TS thrombosis and 100% and 94.4% for left TS thrombosis. In conclusion, CE-TCCS shows high identification rates of cerebral veins and sinuses and a high diagnostic accuracy for SS and TS thrombosis.
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Affiliation(s)
- Xueli Zhu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mengze Liu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiping Gong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhanqiang Jin
- Department of Ultrasound, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Fumin Wang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiji Wei
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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A Preliminary Study of Neonatal Cranial Venous System by Color Doppler. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7569479. [PMID: 31183374 PMCID: PMC6512013 DOI: 10.1155/2019/7569479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022]
Abstract
Aim To present anatomic data in the ultrasound planes for the identification of the major veins and the venous sinuses in cerebrum and to establish the sonographic normal reference values for the visualization of vein vessels and vein sinuses and blood flow velocities. Methods This study involved 55 healthy full-term neonates for transfontanellar color Doppler sonography. The imaging included both sagittal and coronal planes with LA332E probe, supplemented with PA240 probe as necessary. As low as reasonably achievable (ALARA) principle was obeyed, limiting Doppler exposure time and maximizing signal intensity by increasing gain rather than outputting transducer power settings. The output power was kept at a minimum level consistent with recording an adequate signal. Keeping the newborns in calm state, the total examination time which every neonate required was less than 5 min. All images were stored also in a workstation for further analysis. The description statistics and t-test for statistical analysis were used. Result In all studied cases (100% cases), subependymal veins (SV), internal cerebral veins (ICV), Galen vein (GV), straight sinus (SS), superior sagittal sinus (SSS), and transverse sinuses (TS) were visualized. The visualization percentages of inferior sagittal sinus (ISS) or basal veins/Rosenthal veins (BV/RV) were lower than 100%. Based on vessel visualization percentage from high to low, the vessels were ordered as follows: SV, ICV, BV, SS, TS, ISS, and SSS. In SSS and TS, the pulsation percentage was 100%. The descending percentages of vessel pulsation were noted in SS, BV, ICV, and SV. On the basis of the mean of maximum velocities of the vessels from low to high, the vessels were ordered as follows: ISS, BV-L, BV-R, ICV-R, ICV-L, SV-L, SV-R, SSS, TS-L, TS-R, and SS. Conclusion The measurements percent of visualization of cerebral deep veins was higher than the percent of cerebral venous sinuses. The pulsation percent of measurement and the velocities of cerebral venous sinuses were absolutely higher than the cerebral deep venous system. The pairs of vascular blood flow velocities were nonsignificantly different from one another.
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Puppo C, Kasprowicz M, Steiner LA, Yelicich B, Lalou DA, Smielewski P, Czosnyka M. Hypocapnia after traumatic brain injury: how does it affect the time constant of the cerebral circulation? J Clin Monit Comput 2019; 34:461-468. [PMID: 31175502 PMCID: PMC7223592 DOI: 10.1007/s10877-019-00331-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/30/2019] [Indexed: 11/09/2022]
Abstract
The time constant of the cerebral arterial bed (“tau”) estimates how fast the blood entering the brain fills the arterial vascular sector. Analogous to an electrical resistor–capacitor circuit, it is expressed as the product of arterial compliance (Ca) and cerebrovascular resistance (CVR). Hypocapnia increases the time constant in healthy volunteers and decreases arterial compliance in head trauma. How the combination of hyocapnia and trauma affects this parameter has yet to be studied. We hypothesized that in TBI patients the intense vasoconstrictive action of hypocapnia would dominate over the decrease in compliance seen after hyperventilation. The predominant vasoconstrictive response would maintain an incoming blood volume in the arterial circulation, thereby lengthening tau. We retrospectively analyzed recordings of intracranial pressure (ICP), arterial blood pressure (ABP), and blood flow velocity (FV) obtained from a cohort of 27 severe TBI patients [(39/30 years (median/IQR), 5 women; admission GCS 6/5 (median/IQR)] studied during a standard clinical CO2 reactivity test. The reactivity test was performed by means of a 50-min increase in ventilation (20% increase in respiratory minute volume). CVR and Ca were estimated from these recordings, and their product calculated to find the time constant. CVR significantly increased [median CVR pre-hypocapnia/during hypocapnia: 1.05/1.35 mmHg/(cm3/s)]. Ca decreased (median Ca pre-hypocapnia/during hypocapnia: 0.130/0.124 arbitrary units) to statistical significance (p = 0.005). The product of these two parameters resulted in a significant prolongation of the time constant (median tau pre-hypocapnia/during hypocapnia: 0.136 s/0.152 s, p ˂ .001). Overall, the increase in CVR dominated over the decrease in compliance, hence tau was longer. We demonstrate a significant increase in the time constant of the cerebral circulation during hypocapnia after severe TBI, and attribute this to an increase in cerebrovascular resistance which outweighs the decrease in cerebral arterial bed compliance.
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Affiliation(s)
- Corina Puppo
- Intensive Care Unit, Hospital de Clinicas, Universidad de la Republica, Av. Italia s/n, 11600, Montevideo, Uruguay.
| | - Magdalena Kasprowicz
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, wybrzeże Stanisława Wyspiańskiego 27, 50-370, Wroclaw, Poland
| | - Luzius A Steiner
- Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Bernardo Yelicich
- Intensive Care Unit, Hospital de Clinicas, Universidad de la Republica, Av. Italia s/n, 11600, Montevideo, Uruguay
| | - Despina Afrodite Lalou
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Peter Smielewski
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Marek Czosnyka
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, UK
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Imaging of CSF Spaces, Physiology, and Hydrodynamics. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_5-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Imaging of CSF Spaces: Anatomy, Physiology, and Hydrodynamics. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Connolly F, Schreiber SJ, Leithner C, Bohner G, Vajkoczy P, Valdueza JM. Assessment of intracranial venous blood flow after subarachnoid hemorrhage: a new approach to diagnose vasospasm with transcranial color-coded duplex sonography. J Neurosurg 2018; 129:1136-1142. [PMID: 29243981 DOI: 10.3171/2017.5.jns17232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVETranscranial color-coded duplex sonography (TCCS) is a reliable tool that is used to assess vasospasm in the M1 segment of the middle cerebral artery (MCA) after subarachnoid hemorrhage (SAH). A distinct increase in blood flow velocity (BFV) is the principal criterion for vasospasm. The MCA/internal carotid artery (ICA) index (Lindegaard Index) is also widely used to distinguish between vasospasm and cerebral hyperperfusion. However, extracranial ultrasonography assessment of the neck vessels might be difficult in an intensive care unit. Therefore, the authors evaluated whether the relationship of intracranial arterial to venous BFV might indicate vasospasm with similar or even better accuracy.METHODSPatients who presented between 2008 and 2015 with aneurysmal SAH were prospectively enrolled in the study. Digital subtraction angiography (DSA) and TCCS were performed within 24 hours of each other to assess vasospasm 8-10 days after SAH. The following different TCCS parameters were analyzed to assess vasospasm in the MCA and were compared with the gold-standard DSA parameters: 1) mean time-averaged maximum BFV (Vmean) of the MCA, 2) peak systolic velocity (PSV) of the MCA, 3) the Lindegaard Index using Vmean as well as PSV, and 4) a new arteriovenous index (AVI) between the MCA and the basal vein of Rosenthal using Vmean and PSV. The best cutoff values for these parameters to distinguish vasospasm from normal perfusion or hyperperfusion were calculated using receiver operating characteristic curve analysis. Sensitivity, specificity, positive predictive value, and negative predictive value as well as the overall accuracy for each cutoff value were analyzed.RESULTSA total of 102 patients (mean age 52 ± 12 years) were evaluated. Bilateral MCA assessment by TCCS was successful in all patients. In 6 cases (3%), the BFV of the basal vein of Rosenthal could not be analyzed. The AVI could not be calculated in 50 of 204 cases (25%) because the insonation quality was very low in one of the ICAs. An AVI > 10 for Vmean and an AVI > 12 for systolic velocity provided the highest accuracies of 87% and 86%, respectively. Regarding the Lindegaard Index, the accuracy was highest using a threshold of > 3 for the mean BFV (84%) as well as systolic BFV (80%). BFVs in the MCA of ≥ 120 cm/sec (Vmean) and ≥ 200 cm/sec (PSV) predicted vasospasm with accuracies of 84% and 83%, respectively. A combined analysis of the MCA BFV and the AVI led to a slight increase in specificity (Vmean, 94%; PSV, 93%) and positive predictive value (Vmean, 88%; PSV 86%) without further improvement in accuracy (Vmean, 88%; PSV, 84%).CONCLUSIONSThe intracranial AVI is a reliable parameter that can be used to assess vasospasm after SAH. Its reliability for differentiating vasospasm and hyperperfusion is slightly higher than that for the established Lindegaard Index, and this method has the additional advantage of a remarkably lower failure rate.
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Affiliation(s)
| | | | | | | | | | - José M Valdueza
- 4Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany
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Baghdasaryan D, Albrecht M, Shahnazaryan M, Rosahl S. Real-Time Ultrasound Doppler Enhances Precision in Image-Guided Approaches to the Cerebellopontine Angle. World Neurosurg 2017; 107:482-487. [PMID: 28804044 DOI: 10.1016/j.wneu.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/30/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate efficacy and reliability of intraoperative Doppler sonography in localizing the transverse and sigmoid sinuses during lateral suboccipital craniotomy. METHODS A 16-Mhz intraoperative micro-Doppler ultrasound (16Mhz, Multi-Dop pro, Compumedics, Singen, Germany) was applied to detect the medial border of the sigmoid sinus and the inferior border of the transverse sinus in 25 patients. Micro-Doppler measurements were compared with magnetic resonance- and computed tomography-based image guidance (Kolibri, Brainlab, Munich, Germany). Visual detectability of the sinuses with the operating microscope was also documented. RESULTS Inadvertent incision of the transverse or sigmoid sinuses did not occur in any patient when the 2 localizing methods have been used in combination. The mean mismatch of image-guided system and micro-Doppler was 2.64 mm (range, 0-6 mm; standard deviation, 1.55 mm). With the microscope the transverse sinus was invisible in 7 patients, the sigmoid sinus was visually undetectable in 1 case. The micro-Doppler indicated blood flow outside the visible borders of the sinuses in 5 patients. CONCLUSIONS A combination of image-guidance and micro-Doppler enhances the accuracy in localizing the margins of the transverse and sigmoid sinuses using the retrosigmoid approach, thus preventing inadvertent injury. The method could potentially be applied during other craniotomies involving the exposure of a venous sinus.
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Affiliation(s)
- Davit Baghdasaryan
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany; Department of Neurosurgery, Yerevan State Medical University, Yerevan, Armenia.
| | - Marcel Albrecht
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany
| | | | - Steffen Rosahl
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany
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13
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Dempfle AK, Harloff A, Schuchardt F, Bäuerle J, Yang S, Urbach H, Egger K. Longitudinal Volume Quantification of Deep Medullary Veins in Patients with Cerebral Venous Sinus Thrombosis. Clin Neuroradiol 2017; 28:493-499. [DOI: 10.1007/s00062-017-0602-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/22/2017] [Indexed: 12/17/2022]
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14
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Mao D, Li Y, Liu P, Peng SL, Pillai JJ, Lu H. Three-dimensional mapping of brain venous oxygenation using R2* oximetry. Magn Reson Med 2017; 79:1304-1313. [PMID: 28585238 DOI: 10.1002/mrm.26763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/07/2017] [Accepted: 05/03/2017] [Indexed: 11/11/2022]
Abstract
PURPOSE Cerebral venous oxygenation (Yv ) is an important biomarker for brain diseases. This study aims to develop an R2*-based MR oximetry that can measure cerebral Yv in 3D. METHODS This technique separates blood signal from tissue by velocity-encoding phase contrast and measures the R2* of pure blood by multi-gradient-echo acquisition. The blood R2* was converted to Yv using an R2*-versus-oxygenation (Y) calibration curve, which was obtained by in vitro bovine blood experiments. Reproducibility, sensitivity, validity, and resolution dependence of the technique were evaluated. RESULTS In vitro R2*-Y calibration plot revealed a strong dependence of blood R2* on oxygenation, with additional dependence on hematocrit. In vivo results demonstrated that the technique can provide a 3D venous oxygenation map that depicts both large sinuses and smaller cortical veins, with venous oxygenation ranging from 57 to 72%. Intrasession coefficient of variation of the measurement was 3.0%. The technique detected an average Yv increase of 10.8% as a result of hyperoxia, which was validated by global oxygenation measurement from T2 -Relaxation-Under-Spin-Tagging (TRUST) MRI. Two spatial resolutions, one with an isotropic voxel dimension and the other with a nonisotropic dimension, were tested for full brain coverage. CONCLUSIONS This study demonstrated the feasibility of 3D brain oxygenation mapping without using contrast agent. Magn Reson Med 79:1304-1313, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Deng Mao
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yang Li
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Peiying Liu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shin-Lei Peng
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Jay J Pillai
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Abstract
AbstractFrom the earliest pathological studies the perivenular localization of the demyelination in multiple sclerosis (MS) has been observed. It has recently been suggested that obstructions to venous flow or inadequate venous valves in the great veins in the neck, thorax and abdomen can cause damaging backflow into the cerebral and spinal cord circulations. Paolo Zamboni and colleagues have demonstrated abnormal venous circulation in some multiple sclerosis patients using non-invasive sonography and invasive venography. Furthermore, they have obtained apparent clinical improvement or stabilization by endovascular ballooning of points of obstruction in the great veins in some, at least temporarily. If non-invasive observations by others validate their initial observations of a significantly increased prevalence of venous obstructions in MS then trials of angioplasty/stenting would be justified in selected cases in view of the biological plausibility of the concept.
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16
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Zhang Z, Deng X, Weng D, An J, Zuo Z, Wang B, Wei N, Zhao J, Xue R. Segmented TOF at 7 T MRI: Technique and clinical applications. Magn Reson Imaging 2015. [DOI: 10.1016/j.mri.2015.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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In vivo analysis of physiological 3D blood flow of cerebral veins. Eur Radiol 2015; 25:2371-80. [PMID: 25638218 DOI: 10.1007/s00330-014-3587-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 12/16/2014] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To visualize and quantify physiological blood flow of intracranial veins in vivo using time-resolved, 3D phase-contrast MRI (4D flow MRI), and to test measurement accuracy. METHODS Fifteen healthy volunteers underwent repeated ECG-triggered 4D flow MRI (3 Tesla, 32-channel head coil). Intracranial venous blood flow was analysed using dedicated software allowing for blood flow visualization and quantification in analysis planes at the superior sagittal, straight, and transverse sinuses. MRI was evaluated for intra- and inter-observer agreement and scan-rescan reproducibility. Measurements of the transverse sinuses were compared with transcranial two-dimensional duplex ultrasound. RESULTS Visualization of 3D blood flow within cerebral sinuses was feasible in 100 % and within at least one deep cerebral vein in 87 % of the volunteers. Blood flow velocity/volume increased along the superior sagittal sinus and was lower in the left compared to the right transverse sinus. Intra- and inter-observer reliability and reproducibility of blood flow velocity (mean difference 0.01/0.02/0.02 m/s) and volume (mean difference 0.0002/-0.0003/0.00003 l/s) were good to excellent. High/low velocities were more pronounced (8 % overestimation/9 % underestimation) in MRI compared to ultrasound. CONCLUSIONS Four-dimensional flow MRI reliably visualizes and quantifies three-dimensional cerebral venous blood flow in vivo and is promising for studies in patients with sinus thrombosis and related diseases. KEY POINTS • 4D flow MRI can be used to visualize and quantify physiological cerebral venous haemodynamics • Flow quantification within cerebral sinuses reveals high reliability and accuracy of 4D flow MRI • Blood flow volume and velocity increase along the superior sagittal sinus • Limited spatial resolution currently precludes flow quantification in small cerebral veins.
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18
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Recommendations for Multimodal Noninvasive and Invasive Screening for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal Venous Insufficiency: A Position Statement of the International Society for Neurovascular Disease. J Vasc Interv Radiol 2014; 25:1785-94.e17. [DOI: 10.1016/j.jvir.2014.07.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022] Open
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19
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Harloff A. Cerebral veins-why functional MR imaging is worth the trouble. AJNR Am J Neuroradiol 2014; 35:1007-8. [PMID: 24335540 DOI: 10.3174/ajnr.a3811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Harloff
- Department of Neurology University Medical Center Freiburg, Germany
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20
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Doepp Connolly F, Reitemeier J, Storm C, Hasper D, Schreiber SJ. Duplex sonography of cerebral blood flow after cardiac arrest--a prospective observational study. Resuscitation 2013; 85:516-21. [PMID: 24384507 DOI: 10.1016/j.resuscitation.2013.12.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 10/09/2013] [Accepted: 12/20/2013] [Indexed: 11/17/2022]
Abstract
AIM Despite successful resuscitation, cardiac arrest (CA) often has a poor clinical prognosis. Different diagnostic tools have been established to predict patients' outcome. However, their sensitivity remains low. Assessment of cerebral perfusion by duplex ultrasound might provide additional information regarding the extent of neuronal damage. The aim of the present study was to analyse the changes of global cerebral blood flow (CBF) and intracranial blood flow parameters in the acute stage after CA and its correlation with patients' outcome. METHODS We investigated 54 patients (17-85 years, mean age: 63±17 years) after CA with return of spontaneous circulation on an intensive care unit. All patients received therapeutic hypothermia (TH) for 24 h after CA and reanimation. Serial measurements of CBF as well as intracranial blood flow velocities and pulsatility indices of the middle cerebral artery and the basal vein of Rosenthal were performed within the first 10 days using duplex ultrasound. Clinical outcome was measured using the Cerebral Performance Category. RESULTS Measurements were successful in 53 patients. CBF values differed between 210 and 1100 ml/min. 24 patients (45%) attained a good outcome. No correlation between CBF or intracranial blood flow characteristics and outcome was found. Neither cerebral hypo- nor hyperperfusion was associated with a fatal outcome. CONCLUSION Cerebral perfusion varies widely after CA. Neither hypo- nor hyperperfusion seems to be an independent risk factor for poor outcome. Duplex ultrasound of cerebral haemodynamics after CA is suitable but probably of limited prognostic value.
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Affiliation(s)
| | | | - Christian Storm
- Department of Internal Medicine, University Hospital Charité, Berlin, Germany
| | - Dietrich Hasper
- Department of Internal Medicine, University Hospital Charité, Berlin, Germany
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21
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Tromba L, Blasi S, Vestri A, Kiltzanidi D, Tartaglia F, Redler A. Prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: a blinded sonographic evaluation. Phlebology 2013; 30:52-60. [DOI: 10.1177/0268355513512823] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To verify the prevalence of chronic cerebrospinal venous insufficiency in patients affected by different clinical forms of multiple sclerosis and in healthy subjects using the Zamboni ultrasound protocol combined with M-mode ultrasound examination. Materials and methods: We enrolled 112 patients with multiple sclerosis and 67 healthy subjects from 20 to 67 years of age. All the patients underwent Duplex and color-Doppler sonography of the neck vessels, transcranial colour duplex sonography, M-mode study of the valve system and of venous abnormalities. Subjects were positive for chronic cerebrospinal venous insufficiency when at least two of five hemodynamic criteria of the Zamboni protocol were fulfilled. Chronic cerebrospinal venous insufficiency condition was further analyzed by a multivariate analysis including age, sex, disease duration, subtypes of multiple sclerosis and expanded disability status scale score as independent variables. Results: No healthy subjects was positive for chronic cerebrospinal venous insufficiency, while in the sample of patients affected by multiple sclerosis the diagnosis was made in 59.8% of cases ( p < 0.0001). The first criterion was the most frequent in patients affected by multiple sclerosis and chronic cerebrospinal venous insufficiency (respectively 54.4% and 76.1%, p < 0.001). The second, third and fourth criteria were never present in healthy subjects but were detected in patients with multiple sclerosis. The positivity of the second criterion was associated with diagnosis of chronic cerebrospinal venous insufficiency in 100% of cases. The third criterion had a prevalence of 52.2% in the subgroup of chronic cerebrospinal venous insufficiency patients. It was positive in 36 multiple sclerosis patients and was associated with chronic cerebrospinal venous insufficiency diagnosis in all cases except one. The multivariate analysis showed that age, disease duration, sex, subtypes of multiple sclerosis and expanded disability status scale score were not considered predictors of this haemodynamic condition. Conclusion: Chronic cerebrospinal venous insufficiency is a haemodynamic condition strongly associated with multiple sclerosis and is not found in normal controls. The addition of M-mode ultrasound to the diagnostic protocol allows improved observation of venous valve abnormalities.
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Affiliation(s)
- L Tromba
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - S Blasi
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - A Vestri
- Department of Public health and infectious diseases, Sapienza University, Rome, Italy
| | - D Kiltzanidi
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - F Tartaglia
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - A Redler
- Department of Surgical Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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22
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Ivanov AY, Petrov AE, Vershinina EA, Galagudza MM, Vlasov TD. Evidence of active regulation of cerebral venous tone in individuals undergoing embolization of brain arteriovenous malformations. J Appl Physiol (1985) 2013; 115:1666-71. [PMID: 24114702 DOI: 10.1152/japplphysiol.00951.2013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral venous drainage is generally believed to be regulated primarily by hydrodynamic forces. To gain further insight into the regulation of this process, we investigated the response of blood flow velocity and cross-sectional area (CSA) of the internal jugular veins (IJVs) to local hemodynamic shifts. All procedures and assessments were performed on patients (n = 30) undergoing embolization of brain arteriovenous malformations (AVMs). The procedure efficiency was verified by the postembolization reduction in time-averaged maximum blood flow velocities, as well as the elevation of pulsatility index and resistance index in the arterial feeders. In cerebral veins, the dominant IJV pressure remained unchanged during the procedure. At the same time, AVM embolization caused a significant reduction in maximal CSA (84 ± 7.6 to 68 ± 7.7 mm(2), P < 0.05) and minimal CSA (68 ± 7.0 to 51 ± 7.0 mm(2), P < 0.01) of the IJV located ipsilateral to the AVM, while the maximal linear blood flow velocity in the IJV remained unchanged (71 ± 4.9 and 85 ± 8.4 cm/s, P = 0.098). Consistent with previously published studies, the data obtained provide further evidence of active regulation of the venous outflow, probably mediated by certain neurogenic and/or endothelium-dependent mechanisms.
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Affiliation(s)
- Alexey Y Ivanov
- Division of Vascular Surgery, A. L. Polenov Research Institute of Neurosurgery, St. Petersburg, Russian Federation
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23
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Valdueza JM, Doepp F, Schreiber SJ, van Oosten BW, Schmierer K, Paul F, Wattjes MP. What went wrong? The flawed concept of cerebrospinal venous insufficiency. J Cereb Blood Flow Metab 2013; 33:657-68. [PMID: 23443168 PMCID: PMC3652697 DOI: 10.1038/jcbfm.2013.31] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency ('CCSVI'). The diagnosis of 'CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of 'CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the 'CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the 'CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat 'CCSVI' in the care of MS patients, outside of the setting of scientific research.
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Affiliation(s)
- José M Valdueza
- Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany.
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24
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Barreto AD, Brod SA, Bui TT, Jemelka JR, Kramer LA, Ton K, Cohen AM, Lindsey JW, Nelson F, Narayana PA, Wolinsky JS. Chronic cerebrospinal venous insufficiency: case-control neurosonography results. Ann Neurol 2013; 73:721-8. [PMID: 23418024 PMCID: PMC3657573 DOI: 10.1002/ana.23839] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/05/2012] [Accepted: 12/07/2012] [Indexed: 11/09/2022]
Abstract
Objective Chronic cerebrospinal venous insufficiency (CCSVI) has been implicated in the pathophysiology of multiple sclerosis (MS). We sought to determine whether neurosonography (NS) provides reliable information on cerebral venous outflow patterns specific to MS. Methods This was a single-center, prospective case–control study of volunteer MS and non-MS participants. A neurosonologist, blind to the subjects' diagnosis, used high-resolution B-mode imaging with color and spectral Doppler to systematically investigate, capture, and record extracranial and intracranial venous drainage. These neuroimaging results were evaluated and scored by an expert blinded to subjects' information and with no interactions with the participants. Results Altogether, 276 subjects were studied: 206 with MS and 70 non-MS. MS patients were older than non-MS subjects (48.3±9.9 vs 44.3±11.8 years, p<0.007), with durations from first symptoms and diagnosis of 13.7±10 and 9.9±7.8 years, and Expanded Disability Status Scale of 2.6±2.0. Overall, 82 subjects (29.7%) fulfilled 1 of 5 NS criteria proposed for CCSVI; 13 (4.7%) fulfilled 2 criteria required for diagnosis, and none fulfilled >2 criteria. The distribution of subjects with 0, 1, or 2 criteria did not differ significantly across all diagnostic groupings, between MS and non-MS subjects, or within MS subgroups. CCSVI was present in 7.14% of non-MS and 3.88% of MS patients (p=0.266). No significant differences emerged between MS and non-MS subjects for extracranial or intracranial venous flow rates. Interpretation NS findings described as CCSVI are much less prevalent than initially reported, and do not distinguish MS from other subjects. Our findings do not support the hypothesis that CCSVI is causally associated with MS. ANN NEUROL 2013;73:721–728
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Affiliation(s)
- Andrew D Barreto
- Departments of Neurology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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25
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Kopelman M, Glik A, Greenberg S, Shelef I. Intracranial nonjugular venous pathways: a possible compensatory drainage mechanism. AJNR Am J Neuroradiol 2013; 34:1348-52. [PMID: 23370471 DOI: 10.3174/ajnr.a3402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The IJVs are considered to be the main pathway draining the intracranial venous system. There is increasing evidence for the existence of alternative venous pathways. Studies using extracranial sonography techniques have demonstrated a nonjugular venous system. In the current study, we used MR images to investigate the NJV drainage system and its components (vertebral plexus, pterygopalatine plexus). The exact visualization and measurement of the intracranial NJVs could be of diagnostic importance and may have clinical importance. MATERIALS AND METHODS A total of 64 participants with no history of neurologic disease were included in the study. All participants underwent scanning with a 2D time-of-flight, multisection sequence in the supine position. Image processing software was developed to identify and quantify the size of the IJVs and NJVs in the plane of the internal JF. For evaluation of software accuracy, all images were reviewed by a neuroradiologist experienced in neurovascular imaging preprocessing and postprocessing. RESULTS The CSA of the NJVs correlated inversely with the CSA of the IJVs (r(2) = 0.25; P < .0001). An inverse correlation was also significant when comparing IJV with NJV components (vertebral plexus: r(2) = 0.19; P = .0004; pterygopalatine plexus: r(2) = 0.11; P = .0069). Furthermore, only NJV cumulative CSA correlated inversely with participant age (r(2) = 0.2; P = .0002). CONCLUSIONS Our study indicates that the NJVs might serve as a compensatory drainage mechanism in the intracranial compartment. This mechanism appears less significant as the age of the patient progresses.
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Affiliation(s)
- M Kopelman
- Department of Biomedicine Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel
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26
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Blinkenberg M, Åkeson P, Sillesen H, Lövgaard S, Sellebjerg F, Paulson OB, Siebner HR, Sørensen PS. Chronic cerebrospinal venous insufficiency and venous stenoses in multiple sclerosis. Acta Neurol Scand 2012; 126:421-7. [PMID: 22530753 DOI: 10.1111/j.1600-0404.2012.01671.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The traditional view that multiple sclerosis (MS) is an autoimmune disease has recently been challenged by the claim that MS is caused by chronic cerebrospinal venous insufficiency (CCSVI). Although several studies have questioned this vascular theory, the CCSVI controversy is still ongoing. Our aim was to assess the prevalence of CCSVI in Danish MS patients using sonography and compare these findings with MRI measures of venous flow and morphology. METHODS We investigated cervical and cerebral veins in 24 patients with relapsing-remitting MS (RRMS) and 15 healthy controls, using extracranial high-resolution ultrasound colour Doppler (US-CD) and transcranial colour Doppler sonography (TCDS), as well as magnetic resonance imaging (MRI) and phase-contrast MR blood flow measurements (PC-MR) of the cervical veins. RESULTS US-CD could not identify the left internal jugular vein (IJV) in one MS patient, other ultrasound examinations were normal in patients with MS. There was no difference in mean cross-sectional area of the IJV in MS patients compared with controls. Only one patient with MS and two healthy controls fulfilled one CCSVI criterion, and none fulfilled more than one CCSVI criterion. MR venography showed insignificant IJV stenosis (1-49%) in two patients with MS, whereas 50-69% IJV stenosis was detected in two healthy controls. There was no difference in PC-MR measurements of mean IJV blood flow between patients with MS and controls. CONCLUSION Our results do not corroborate the presence of vascular pathology in RRMS and we found no evidence supporting the CCSVI hypothesis.
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Affiliation(s)
- M. Blinkenberg
- Department of Neurology; Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet; Copenhagen; Denmark
| | - P. Åkeson
- Danish Research Centre for Magnetic Resonance; Copenhagen University Hospital; Hvidovre; Denmark
| | - H. Sillesen
- Department of Vascular Surgery; Copenhagen University Hospital, Rigshospitalet; Copenhagen; Denmark
| | - S. Lövgaard
- Department of Vascular Surgery; Copenhagen University Hospital, Rigshospitalet; Copenhagen; Denmark
| | - F. Sellebjerg
- Department of Neurology; Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet; Copenhagen; Denmark
| | | | - H. R. Siebner
- Danish Research Centre for Magnetic Resonance; Copenhagen University Hospital; Hvidovre; Denmark
| | - P. S. Sørensen
- Department of Neurology; Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet; Copenhagen; Denmark
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27
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Van den Berg PJ, Van den Berg GB, Westerhuis LW, Visser LH. Occurrence of
CCSVI
in patients with
MS
and its relationship with iron metabolism and varicose veins. Eur J Neurol 2012; 20:519-526. [DOI: 10.1111/ene.12010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/10/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - G. B. Van den Berg
- Department of Clinical Chemistry and Hematology St Elisabeth Hospital TilburgThe Netherlands
| | - L. W. Westerhuis
- Department of Clinical Chemistry and Hematology St Elisabeth Hospital TilburgThe Netherlands
| | - L. H. Visser
- Department of Neurology St Elisabeth Hospital TilburgThe Netherlands
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Patti F, Nicoletti A, Leone C, Messina S, D’Amico E, Lo Fermo S, Paradisi V, Bruno E, Quattrocchi G, Veroux P, Di Pino L, Costanzo L, Zappia M. Multiple sclerosis and CCSVI: a population-based case control study. PLoS One 2012; 7:e41227. [PMID: 22870210 PMCID: PMC3411668 DOI: 10.1371/journal.pone.0041227] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/19/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chronic cerebrospinal venous insufficiency (CCSVI) has been associated to multiple sclerosis (MS). OBJECTIVE To evaluate the possible association between CCSVI and MS, using a population-based control design. METHODS A random cohort of 148 incident MS patients were enrolled in the study. We have also studied 20 patients with clinically isolated syndrome (CIS), 40 patients with other neurological diseases (OND), and 172 healthy controls. Transcranial (TCC) and Echo Color Doppler (ECD) were carried out in 380 subjects. A subject was considered CCSVI positive if ≥2 venous hemodynamic criteria were fulfilled. RESULTS CCSVI was present in 28 (18.9%) of the MS patients, in 2 (10%) of CIS patients, in 11 (6.4%) of the controls, and in 2 (5%) of the OND patients. A significant association between MS and CCSVI was found with an odds ratio of 3.41 (95% confidence interval 1.63-7.13; p = 0.001). CCSVI was significantly more frequent among MS subjects with a disease duration longer than 144 months (26.1% versus 12.6% of patients with duration shorter than 144 months; p = 0.03) and among patients with secondary progressive (SP) and primary progressive (PP) forms (30.2% and 29.4, respectively) than in patients with relapsing remitting (RR) MS (14.3%). A stronger association was found considering SP and PP forms (age adjusted OR = 4.7; 95% CI 1.83-12.0, p = 0.001); the association was weaker with the RR patients (age adjusted OR = 2.58; 95%CI 1.12-5.92; p = 0.02) or not significant in CIS group (age adjusted OR = 2.04; 95%CI 0.40-10.3; p = 0.4). CONCLUSIONS A higher frequency of CCSVI has been found in MS patients; it was more evident in patients with advanced MS, suggesting that CCSVI could be related to MS disability.
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Affiliation(s)
- Francesco Patti
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Carmela Leone
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Silvia Messina
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Emanuele D’Amico
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Salvatore Lo Fermo
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Vincenza Paradisi
- FIMG (Italian Federation of General Medicine), Catania Municipality Section, Catania, Italy
| | - Elisa Bruno
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Graziella Quattrocchi
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Luigi Di Pino
- Department of Cardiology, University of Catania, Catania, Italy
| | - Luca Costanzo
- Department of Cardiology, University of Catania, Catania, Italy
| | - Mario Zappia
- Department DANA GF Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
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Mokin M, Kan P, Abla AA, Kass-Hout T, Snyder KV, Levy EI, Siddiqui AH. Intravascular ultrasound in the evaluation and management of cerebral venous disease. World Neurosurg 2012; 80:655.e7-13. [PMID: 22484769 DOI: 10.1016/j.wneu.2012.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/13/2012] [Accepted: 04/03/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) is an important diagnostic tool in many interventions, particularly coronary and carotid artery angioplasty and stenting. In contrast, its application in the management of diseases of the cerebral venous system remains an unexplored territory. We report three patients in whom IVUS was used during angiography for the evaluation of venous flow obstruction secondary to venous sinus thrombosis, venous sinus stenosis, and a transverse sinus mass lesion, respectively. In addition, we review current literature to summarize previous experience, focusing on the advantages and limitations of IVUS technology in interventional cardiology, carotid artery disease, and venous disease. CASE DESCRIPTIONS In all three cases, IVUS was used without any complications and provided critical information that guided further management of these distinct diseases. IVUS helped diagnose the presence of intraluminal thrombus, severe stenosis, and a mass lesion in the transverse sinuses and also helped assess the response to angioplasty of the stenotic regions. CONCLUSIONS IVUS is a promising tool that has potential to improve diagnostic accuracy and to guide the management of several diseases of the cerebral venous system. The cases we describe suggest that IVUS can be successfully used when performing endovascular interventions in patients with obstruction of venous outflow secondary to venous sinus stenosis, thrombosis, or mass lesions.
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Affiliation(s)
- Maxim Mokin
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA
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Kasprowicz M, Diedler J, Reinhard M, Carrera E, Smielewski P, Budohoski KP, Sorrentino E, Haubrich C, Kirkpatrick PJ, Pickard JD, Czosnyka M. Time Constant of the Cerebral Arterial Bed. ACTA NEUROCHIRURGICA SUPPLEMENTUM 2012; 114:17-21. [DOI: 10.1007/978-3-7091-0956-4_4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Zamboni P, Menegatti E, Pomidori L, Morovic S, Taibi A, Malagoni AM, Cogo AL, Gambaccini M. Does thoracic pump influence the cerebral venous return? J Appl Physiol (1985) 2011; 112:904-10. [PMID: 22174396 DOI: 10.1152/japplphysiol.00712.2011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We assessed the hemodynamic effects induced by the thoracic pump in the intra- and extracranial veins of the cerebral venous system on healthy volunteers. Activation of the thoracic pump was standardized among subjects by setting the deep inspiration at 70% of individual vital capacity. Peak velocity (PV), time average velocity (TAV), vein area (VA), and flow quantification (Q) were assessed by means of echo color Doppler in supine posture. Deep respiration significantly increases PV, TAV, and Q, but it is limited to the extracranial veins. To the contrary, no significant hemodynamic changes were recorded at the level of the intracranial venous network. Moreover, at rest TAV in the jugular veins was significantly correlated with Q of the intracranial veins. We conclude that the modulation of the atmospheric pressure operated by the thoracic pump significantly modifies the hemodynamics of the jugular veins and of the reservoir of the neck and facial veins, with no effect on the vein network of the intracranial compartment.
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Affiliation(s)
- Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy
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Zamboni P, Menegatti E, Viselner G, Morovic S, Bastianello S. Fusion imaging technology of the intracranial veins. Phlebology 2011; 27:360-7. [DOI: 10.1258/phleb.2011.011069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Fusion imaging technology (FIT) combines different imaging techniques by means of properly designed software. The aim of this study was to validate the ultrasonographic representation of intracranial vein anatomy by combining transcranial echo-colour Doppler (TECD) with conventional magnetic resonance imaging (MRI). In addition, we investigated the possibility of insonating the veins of the base of the skull through the novel condylar window. Methods We examined venous brain circulation in five healthy subjects by means of FIT, using a 1.5 T MR scanner and an ultrasound TECD equipped with Virtual Navigator technology. Results and conclusions Insonation of the Rosenthal and other intracranial veins through the classical transtemporal window, based on anatomical assumption, but never before validated by means of FIT study, was confirmed. Moreover, in all five subjects, FIT demonstrated the possibility of insonating the petrosal sinuses and the cavernous sinus area through the novel transcondylar approach. In conclusion, the feasibility of FIT of the intracranial veins potentially permits to study subjects in different postures and/or at the bed of non-transportable patients, after the initial MRI acquisition. Finally, the novel transcondylar approach allows obtaining haemodynamic information from the cavernous and the petrosal sinuses usually not investigated by TECD alone.
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Affiliation(s)
- P Zamboni
- Vascular Disease Center, University of Ferrara, Ferrara
| | - E Menegatti
- Vascular Disease Center, University of Ferrara, Ferrara
| | - G Viselner
- Neuroradiological Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino, University of Pavia, Pavia, Italy
| | - S Morovic
- Vascular Disease Center, University of Ferrara, Ferrara
| | - S Bastianello
- Neuroradiological Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino, University of Pavia, Pavia, Italy
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Mayer CA, Pfeilschifter W, Lorenz MW, Nedelmann M, Bechmann I, Steinmetz H, Ziemann U. The perfect crime? CCSVI not leaving a trace in MS. J Neurol Neurosurg Psychiatry 2011; 82:436-40. [PMID: 21296899 PMCID: PMC3061048 DOI: 10.1136/jnnp.2010.231613] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disease of the central nervous system, believed to be triggered by an autoimmune reaction to myelin. Recently, a fundamentally different pathomechanism termed 'chronic cerebrospinal venous insufficiency' (CCSVI) was proposed, provoking significant attention in the media and scientific community. METHODS Twenty MS patients (mean age 42.2 ± 13.3 years; median Extended Disability Status Scale 3.0, range 0-6.5) were compared with 20 healthy controls. Extra- and intracranial venous flow direction was assessed by colour-coded duplex sonography, and extracranial venous cross-sectional area (VCSA) of the internal jugular and vertebral veins (IJV/VV) was measured in B-mode to assess the five previously proposed CCSVI criteria. IJV-VCSA ≤ 0.3 cm(2) indicated 'stenosis,' and IJV-VCSA decrease from supine to upright position 'reverted postural control.' The sonographer, data analyser and statistician were blinded to the patient/control status of the participants. RESULTS No participant showed retrograde flow of cervical or intracranial veins. IJV-VCSA ≤ 0.3 cm(2) was found in 13 MS patients versus 16 controls (p=0.48). A decrease in IJV-VCSA from supine to upright position was observed in all participants, but this denotes a physiological finding. No MS patient and one control had undetectable IJV flow despite deep inspiration (p=0.49). Only one healthy control and no MS patients fulfilled at least two criteria for CCSVI. CONCLUSIONS This triple-blinded extra- and transcranial duplex sonographic assessment of cervical and cerebral veins does not provide supportive evidence for the presence of CCSVI in MS patients. The findings cast serious doubt on the concept of CCSVI in MS.
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Affiliation(s)
- Christoph A Mayer
- Department of Neurology, Goethe-University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany.
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Abstract
Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials.
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Affiliation(s)
- P Zamboni
- Vascular Disease Centre, Interventional Radiology Unit, University of Ferrara, 44100 Ferrara, Italy.
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35
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Baracchini C, Perini P, Calabrese M, Causin F, Rinaldi F, Gallo P. No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol 2011; 69:90-9. [DOI: 10.1002/ana.22228] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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36
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Meairs S, Hennerici M, Mohr J. Ultrasonography. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Krogias C, Schröder A, Wiendl H, Hohlfeld R, Gold R. „Chronische zerebrospinale venöse Insuffizienz“ und Multiple Sklerose. DER NERVENARZT 2010; 81:740-6. [DOI: 10.1007/s00115-010-2972-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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38
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Khan O, Filippi M, Freedman MS, Barkhof F, Dore-Duffy P, Lassmann H, Trapp B, Bar-Or A, Zak I, Siegel MJ, Lisak R. Chronic cerebrospinal venous insufficiency and multiple sclerosis. Ann Neurol 2010; 67:286-90. [PMID: 20373339 DOI: 10.1002/ana.22001] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Omar Khan
- Multiple Sclerosis Center, Department of Neurology, Wayne State University School of Medicine, 4201 St Antoine, Detroit, MI 48323, USA.
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Puig J, Pedraza S, Blasco G, Serena J. Actualización en el diagnóstico neurorradiológico de la trombosis venosa cerebral. RADIOLOGIA 2009; 51:351-61. [DOI: 10.1016/j.rx.2009.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/16/2009] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
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40
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Kim DJ, Kasprowicz M, Carrera E, Castellani G, Zweifel C, Lavinio A, Smielewski P, Sutcliffe MPF, Pickard JD, Czosnyka M. The monitoring of relative changes in compartmental compliances of brain. Physiol Meas 2009; 30:647-59. [PMID: 19498218 DOI: 10.1088/0967-3334/30/7/009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The study aimed to develop a computational method for assessing relative changes in compartmental compliances within the brain: the arterial bed and the cerebrospinal space. The method utilizes the relationship between pulsatile components in the arterial blood volume, arterial blood pressure (ABP) and intracranial pressure (ICP). It was verified by using clinical recordings of intracranial pressure plateau waves, when massive vasodilatation accompanying plateau waves produces changes in brain compliances of the arterial bed (C(a)) and compliance of the cerebrospinal space (C(i)). Ten patients admitted after head injury with a median Glasgow Coma Score of 6 were studied retrospectively. ABP was directly monitored from the radial artery. Changes in the cerebral arterial blood volume were assessed using Transcranial Doppler (TCD) ultrasonography by digital integration of inflow blood velocity. During plateau waves, ICP increased (P = 0.001), CPP decreased (P = 0.001), ABP remained constant (P = 0.532), blood flow velocity decreased (P = 0.001). Calculated compliance of the arterial bed C(a) increased significantly (P = 0.001); compliance of the CSF space C(i) decreased (P = 0.001). We concluded that the method allows for continuous monitoring of relative changes in brain compartmental compliances. Plateau waves affect the balance between vascular and CSF compartments, which is reflected by the inverse change of compliance of the cerebral arterial bed and global compliance of the CSF space.
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Affiliation(s)
- Dong-Joo Kim
- Academic Neurosurgical Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. Department of Engineering, University of Cambridge, Cambridge, UK
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Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Tacconi G, Dall'Ara S, Bartolomei I, Salvi F. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80:392-9. [PMID: 19060024 PMCID: PMC2647682 DOI: 10.1136/jnnp.2008.157164] [Citation(s) in RCA: 454] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have not previously been investigated. METHODS Sixty-five patients affected by CDMS, and 235 controls composed, respectively, of healthy subjects, healthy subjects older than CDMS patients, patients affected by other neurological diseases and older controls not affected by neurological diseases but scheduled for venography (HAV-C) blindly underwent a combined transcranial and extracranial colour-Doppler high-resolution examination (TCCS-ECD) aimed at detecting at least two of five parameters of anomalous venous outflow. According to the TCCS-ECD screening, patients and HAV-C further underwent selective venography of the azygous and jugular venous system with venous pressure measurement. RESULTS CDMS and TCCS-ECD venous outflow anomalies were dramatically associated (OR 43, 95% CI 29 to 65, p<0.0001). Subsequently, venography demonstrated in CDMS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments; this provides a picture of chronic cerebrospinal venous insufficiency (CCSVI) with four different patterns of distribution of stenosis and substitute circle. Moreover, relapsing-remitting and secondary progressive courses were associated with CCSVI patterns significantly different from those of primary progressive (p<0.0001). Finally, the pressure gradient measured across the venous stenosies was slightly but significantly higher. CONCLUSION CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin. The location of venous obstructions plays a key role in determining the clinical course of the disease.
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Affiliation(s)
- P Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy.
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Zamboni P, Menegatti E, Galeotti R, Malagoni AM, Tacconi G, Dall'Ara S, Bartolomei I, Salvi F. The value of cerebral Doppler venous haemodynamics in the assessment of multiple sclerosis. J Neurol Sci 2009; 282:21-7. [PMID: 19144359 DOI: 10.1016/j.jns.2008.11.027] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 11/25/2008] [Accepted: 11/27/2008] [Indexed: 11/17/2022]
Abstract
Iron stores in the white and deep grey matter in course of multiple sclerosis (MS) have never been explained and could be related to abnormalities in venous drainage, but this possibility has never before been investigated. From an initial cohort of 320 subjects, after application of exclusion criteria, we selected 109 patients affected by MS, and 177 controls respectively composed by age- and sex-matched, healthy aged, and patients affected by other neurological diseases. They blindly underwent transcranial and extracranial Color-Doppler sonographic examination (TCCS-ECD), aimed at investigating five parameters related to normal cerebral venous outflow haemodynamics. Overall we analyzed 1430 TCSS-ECD parameters. In controls we found 861 normal parameters of cerebral venous return vs. 24 anomalous, whereas in MS 288 parameters were normal and 257 anomalous, respectively. Consequently, each of the considered Doppler haemodynamic parameters, when compared to revised McDonald criteria as a gold standard of MS diagnosis, showed separately a highly significant sensitivity and a noteworthy specificity. However, the detection >or=2 parameters in the same subject, never observed in controls, perfectly overlapped the diagnosis of MS (value, 95%CI: sensitivity 100%, 97-100; specificity 100%, 98-100; positive predictive value 100%, 97-100, negative predictive value 100%, 98-100; p<0.0001). Moreover, this study demonstrates a significant impairment of cerebral venous drainage in patients affected by MS, a mechanism potentially related to increased iron stores.
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Affiliation(s)
- Paolo Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy.
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Mills S, Cain J, Purandare N, Jackson A. Biomarkers of cerebrovascular disease in dementia. Br J Radiol 2008; 80 Spec No 2:S128-45. [PMID: 18445743 DOI: 10.1259/bjr/79217686] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There is increasing recognition that cerebrovascular disease contributes significantly to the development and progression of patients with dementia. The concepts of pure vascular and pure degenerative dementia have been replaced with a recognition that, in many patients, there is a spectrum of neurodegenerative and vascular processes. This is supported by preliminary studies showing response to vascular therapeutics and ventriculo-peritoneal shunting in patients with Alzheimer's disease. This article examines the imaging biomarkers that are available for the characterization of microvascular abnormality in the ageing brain, with particular reference to microvascular angiopathy, cerebral embolic disease, orthostatic hypotension and abnormalities of Monro-Kellie homeostasis.
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Affiliation(s)
- S Mills
- Division of Imaging Science, University of Manchester, Wolfson Molecular Imaging Centre, 27 Palatine Rd, Withington, Manchester, UK
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Hagberg GE, Bianciardi M, Brainovich V, Cassarà AM, Maraviglia B. The effect of physiological noise in phase functional magnetic resonance imaging: from blood oxygen level-dependent effects to direct detection of neuronal currents. Magn Reson Imaging 2008; 26:1026-40. [PMID: 18479875 DOI: 10.1016/j.mri.2008.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 01/14/2008] [Indexed: 11/17/2022]
Abstract
Recently, the possibility to use both magnitude and phase image sets for the statistical evaluation of fMRI has been proposed, with the prospective of increasing both statistical power and the spatial specificity. In the present work, several issues that affect the spatial and temporal stability in fMRI phase time series in the presence of physiologic noise processes are reviewed, discussed and illustrated by experiments performed at 3 T. The observed phase value is a fingerprint of the underlying voxel averaged magnetic field variations. Those related to physiological processes can be considered static or dynamic in relation to the temporal scale of a 2D acquisition and will play out on different spatial scales as well: globally across the entire images slice, and locally depending on the constituents and their relative fractions inside the MRI voxel. The 'static' respiration-induced effects lead to magneto-mechanic scan-to-scan variations in the global magnetic field but may also contribute to local BOLD fluctuations due to respiration-related variations in arterial carbon dioxide. Likewise, the 'dynamic' cardiac-related effects will lead to global susceptibility effects caused by pulsatile motion of the brain as well as local blood pressure-related changes in BOLD and changes in blood flow velocity. Finally, subject motion may lead to variations in both local and global tissue susceptibility that will be especially pronounced close to air cavities. Since dissimilar manifestations of physiological processes can be expected in phase and in magnitude images, a direct relationship between phase and magnitude scan-to-scan fluctuations cannot be assumed a priori. Therefore three different models were defined for the phase stability, each dependent on the relation between phase and magnitude variations and the best will depend on the underlying noise processes. By experiments on healthy volunteers at rest, we showed that phase stability depends on the type of post-processing and can be improved by reducing the low-frequency respiration-induced mechano-magnetic effects. Although the manifestations of physiological noise were in general more pronounced in phase than in magnitude images, due to phase wraps and global Bo effects, we suggest that a phase stability similar to that found in magnitude could theoretically be achieved by adequate correction methods. Moreover, as suggested by our experimental data regarding BOLD-related phase effects, phase stability could even supersede magnitude stability in voxels covering dense microvascular networks with BOLD-related fluctuations as the dominant noise contributor. In the interest of the quality of both BOLD-based and nc-MRI methods, future studies are required to find alternative methods that can improve phase stability, designed to match the temporal and spatial scale of the underlying neuronal activity.
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Affiliation(s)
- Gisela E Hagberg
- Laboratory of Neuroimaging, Foundation Santa Lucia IRCCS, Rome, Italy.
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Mosso M, Schmid-Priscoveanu A, Straumann D, Baumgartner RW. Absence of gravity-dependent modulation of straight sinus flow velocity in healthy humans. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:726-729. [PMID: 18160202 DOI: 10.1016/j.ultrasmedbio.2007.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 07/23/2007] [Accepted: 10/17/2007] [Indexed: 05/25/2023]
Abstract
The influence of whole-body positions on the cerebral blood flow in normal subjects is unclear. Blood flow in cerebral veins and sinuses is continuous, pulsatile and proportional to cerebral blood flow. We examined young healthy volunteers to evaluate peak mean flow velocity (vm) in the straight sinus (SS) assessed by transcranial Doppler sonography in predefined variations of the whole-body pitch position relative to gravity in the presence of a normal (normocarbia) and an impaired (hypercarbia) cerebral autoregulation. A 2 MHz ultrasound probe was fixed with a headband nearby the protuberantia occipitalis externa. Fifteen subjects were seated in a motorized three-dimensional turntable. Vm-SS, blood pressure and heart rate were monitored in five whole-body pitch positions from upright (0 degrees ) to "20 degrees head-hanging" (110 degrees ): 0, 30, 60, 90 and 110 degrees . The experiment was repeated during the inspiration of 5% CO2. Of 15 subjects, 14 showed reliable ultrasound data; the results of one subject with movement artifacts were excluded. Vm-SS values under normocarbia (hypercarbia) were 23.9 +/- 4.2 cm/s (40.9 +/- 6.7 cm/s) at 0 degrees , 23.1 +/- 5.0 cm/s (38.0 +/- 5.0 cm/s) at 30 degrees , 24.9 +/- 5.1 cm/s (39.9 +/- 3.3 cm/s) at 60 degrees , 29.2 +/- 8.5 cm/s (41.0 +/- 4.7 cm/s) at 90 degrees and 27.0 +/- 11.6 cm/s (43.6 +/- 12.1 cm/s) at 110 degrees . Vm-SS measured under normocarbia (p = 0.09) and hypercarbia (p = 0.25) were not affected while subjects were positioned from upright toward "20 degrees head-hanging", whereas blood pressure and heart rate decreased (p < 0.01). Our results suggest that changes of whole-body position from upright to "20 degrees head-hanging" do not alter cerebral blood flow in healthy subjects.
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Affiliation(s)
- Maria Mosso
- Department of Neurology, University Hospital, Zurich, Switzerland
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Duan YY, Zhou XY, Liu X, Gao GD, Zhao ZW, Hou WH, Cao TS. Carotid and Transcranial Color-Coded Duplex Ultrasonography for the Diagnosis of Dural Arteriovenous Fistulas. Cerebrovasc Dis 2008; 25:304-10. [DOI: 10.1159/000118374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 09/18/2007] [Indexed: 11/19/2022] Open
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Aplicaciones del dúplex transcraneal codificado en color en la monitorización del enfermo neurocrítico. Med Intensiva 2007; 31:510-7. [DOI: 10.1016/s0210-5691(07)74858-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stivaros SM, Jackson A. Changing concepts of cerebrospinal fluid hydrodynamics: role of phase-contrast magnetic resonance imaging and implications for cerebral microvascular disease. Neurotherapeutics 2007; 4:511-22. [PMID: 17599715 PMCID: PMC7479718 DOI: 10.1016/j.nurt.2007.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Phase-contrast magnetic resonance imaging (PC-MRI) or flow-sensitive MRI can be used to noninvasively measure intracranial vascular and CSF flow. Monro-Kellie homeostasis is the complex compensatory mechanism for the increase in intracranial blood volume during systole. Through PC-MRI techniques, our understanding of Monro-Kellie homeostasis and the associated intracranial hydrodynamics has greatly improved. Failure of this homeostatic mechanism has been implicated in a wide range of cerebral disorders, including vascular and Alzheimer's dementia, late-onset depression, benign and secondary intracranial hypertension, communicating and normal pressure hydrocephalus, and age-related white matter changes. The most common mode of homeostatic failure is due to vascular disease with decreased cerebral arterial compliance. This has wide-reaching implications in the investigation of patients with cerebral vascular disease. Here we discuss the role of PC-MRI in the study of cerebral hydrodynamics and the current understanding of Monro-Kellie homeostasis in both healthy and disease states. Quantitative assessment of the changes in this homeostatic mechanism using PC-MRI has important implications in the development of biomarkers of vascular involvement in disease with application in diagnosis, treatment planning, phenotype identification, and outcome assessment in clinical trials.
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Affiliation(s)
- Stavros Michael Stivaros
- Imaging Science and Biomedical Engineering, The Medical School, University of Manchester, Oxford Road, M13 9PT UK
| | - Alan Jackson
- Imaging Science and Biomedical Engineering, The Medical School, University of Manchester, Oxford Road, M13 9PT UK
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White H, Venkatesh B. Applications of transcranial Doppler in the ICU: a review. Intensive Care Med 2006; 32:981-94. [PMID: 16791661 DOI: 10.1007/s00134-006-0173-y] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 03/16/2006] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Transcranial Doppler (TCD) ultrasonography is a technique that uses a hand-held Doppler transducer (placed on the surface of the cranial skin) to measure the velocity and pulsatility of blood flow within the intracranial and the extracranial arteries. This review critically evaluates the evidence for the use of TCD in the critical care population. DISCUSSION TCD has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid haemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomies and to diagnose brain death. Technological advances such as M mode, colour Doppler and three-dimensional power Doppler ultrasonography have extended the scope of TCD to include other non-critical care applications including assessment of cerebral emboli, functional TCD and the management of sickle cell disease. CONCLUSIONS Despite publications suggesting concordance between TCD velocity measurements and cerebral blood flow there are few randomized controlled studies demonstrating an improved outcome with the use of TCD monitoring in neurocritical care. Newer developments in this technology include venous Doppler, functional Doppler and use of ultrasound contrast agents.
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Affiliation(s)
- Hayden White
- Queen Elizabeth II Hospital, Department of Anaesthesia, Coopers Plains, QLD, Australia
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50
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Doepp F, Valdueza JM, Schreiber SJ. Serial ultrasound assessment of the basal vein of Rosenthal in HSV encephalitis. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:473-7. [PMID: 16616593 DOI: 10.1016/j.ultrasmedbio.2006.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 12/20/2005] [Accepted: 01/05/2006] [Indexed: 05/08/2023]
Abstract
Herpes simplex virus encephalitis (HSVE) typically affects the baso-temporal brain. The venous blood drainage of this region mainly occurs via the basal vein of Rosenthal (BVR), which can easily be monitored by transcranial color-coded duplex sonography (TCCS), and might be a useful parameter for the activity of the disease. Serial blood flow velocity (BFV) measurements of the BVR and the basal cerebral arteries were performed in five acute HSVE patients by means of transcranial color-coded duplex sonography (TCCS). Remarkable increased BFV of the BVR at the affected side was found in all patients, showing a maximum within the first 8 d of infection followed by a tendency toward normalisation during the next weeks. In comparison, changes of BFV in the basal cerebral arteries were much more heterogeneous. Our findings suggest that TCCS measurements of the BVR might be used as an additional diagnostic bed-side tool to evaluate patients with HSVE during the acute stage.
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Affiliation(s)
- Florian Doepp
- Department of Neurology, University Hospital Charité, Humboldt University, Berlin, Germany.
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