Correlation Between Trans-Stenotic Blood Flow Velocity Differences and the Cerebral Venous Pressure Gradient in Transverse Sinus Stenosis: A Prospective 4-Dimensional Flow Magnetic Resonance Imaging Study

Abstract

BACKGROUND The relationship between trans-stenotic blood flow velocity differences and the cerebral venous pressure gradient (CVPG) in transverse sinus (TS) stenosis (TSS) has not been studied. OBJECTIVE To evaluate the hemodynamic manifestations of TSS and the relationship between trans-stenotic blood flow velocity differences and the CVPG. METHODS Thirty-three patients with idiopathic intracranial hypertension (IIH) or pulsatile tinnitus (PT) and TSS who had undergone diagnostic venography using venous manometry were included in the patient group. Thirty-three volunteers with no stenosis and symptoms were included in the control group. All the 2 groups underwent prospective venous sinus 4-dimensional (4D) flow magnetic resonance imaging (MRI). The average velocity (Vavg) difference and maximum velocity (Vmax) difference between downstream and upstream of the TS in 2 groups were measured and compared. Correlations between the CVPG and trans-stenotic Vavg difference/Vmax difference/index of transverse sinus stenosis (ITSS) were assessed in the patient group. RESULTS The differences in Vavg difference and Vmax difference between the patient and control groups showed a statistical significance (P < .001). The Vavg difference and Vmax difference had a strong correlation with CVPG (R = 0.675 and 0.701, respectively, P < .001) in the patient group. Multivariate linear regression using the stepwise method showed that the Vmax difference and ITSS were correlated with the CVPG (R = 0.752 and R2 = 0.537, respectively; P < .001). CONCLUSION The trans-stenotic blood flow velocity difference significantly correlates with the CVPG in TSS. As a noninvasive imaging modality, 4D flow MRI may be a suitable screening or complimentary tool to decide which TSS may benefit from invasive venous manometry.

Retroauricular/Transcranial Color-Coded Doppler Ultrasound Approach in Junction With Ipsilateral Neck Compression on Real-Time Hydroacoustic Variation of Venous Pulsatile Tinnitus

“…Compared to the only previous imaging study that investigated subjects with diverticulum independently, the V mn detected by the current RCCD technique closely conforms to the results measured by 4D MR ( Li et al, 2021 ), with 7.3% difference in V mn ( Table 6 ); nonetheless, a stark difference in V max is found between their and our results. Additionally, ITSS in this study was also found uncorrelated with the hemodynamic parameters, which is antithetical to the study of Ding et al (2021) , since the Doppler insonation plane was more distant from the center of TSS, from which the sinus flow velocity can decelerate after issuing from a TSS. We reckon that these study discrepancies predominantly result from the fundamental difference in the selection of region/point of interest.…”

“…Venous PT is characterized by the reduction or elimination of a vascular sound when the ipsilateral internal jugular vein (IJV) is compressed ( Mattox and Hudgins, 2008 ; Grewal et al, 2014 ). In addition, anatomical abnormalities related to the structural integrity of the sigmoid plate and the vascular shape are often revealed using imaging modalities ( Dong et al, 2015 ; Cummins et al, 2021 ; Ding et al, 2021 ).…”

“…In addition to the volumetric asymmetry and high sinus flow velocity that are commonly discovered in PT subjects with SSWAs, some authors also speculated that a regional complex vortical flow structure might engender PT ( Hsieh and Wang, 2020 ; Mu et al, 2020 ; Li et al, 2021 ). Considering that (a) the velocity profile varies among individuals with venous PT and (b) vortical flow structure emanates from the transverse–sigmoid junction with or without diverticulum ( Mu et al, 2020 ; Ding et al, 2021 ; Hsieh et al, 2021a ; Li et al, 2021 ; Qiu et al, 2021b ), it is, however, unclear how the velocity and diverticular vortex affect the hydroacoustic production of PT and how fluctuations in the cross-sectional area of the transverse–sigmoid sinus lumen affect the flow acoustics.…”

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment

“…A jet-like flow in the stenosis and downstream of the stenosis was observed in all patients with transverse sinus stenosis. Since increased prevalence of sigmoid sinus diverticulum/dehiscence and transverse sinus stenosis in idiopathic intracranial hypertension did not correlate with the presence of pulsatile tinnitus in another study [ 78 ], there are probably other hemodynamic factors such as intra-stenotic maximum velocity dependent on the local trans-stenotic pressure gradient and complex flow patterns, such as vortex flow, turbulent flow, and helical flow, that are better correlated with pulsatile tinnitus [ 79 ].…”

Evidence of air‐conduction transmission pathway and strategized transtemporal operative techniques for venous pulsatile tinnitus: Combining water occlusion test and operative sensing applications

“… 1 , 10 , 11 In addition to SSWAs, hemodynamic perturbations in the transverse‐sigmoid sinus are considered to contribute to increases in the volume of vascular sound. 10 Such perturbations include: (1) excessive flow kinetic energy in the form of transverse‐sigmoid sinus enlargement (TSSE) or sigmoid sinus ectasia, 5 , 10 , 12 , 13 (2) flow obstructions such as transverse sinus stenosis (TSS) and arachnoid granulation, 14 , 15 , 16 , 17 , 18 and (3) idiopathic intracranial hypertension (IIH). 8 Despite a convoluted relationship among PT, SSWAs, and flow pathologies, the incidence of SSWAs is higher in patients with IIH than in healthy controls and the general PT population.…”