Effects of different morphologic abnormalities on hemodynamics in patients with venous pulsatile tinnitus: A four‐dimensional flow magnetic resonance imaging study

Abstract

The effects of morphologic abnormalities, including sigmoid sinus wall dehiscence (SSWD), transverse sinus stenosis (TSS), and sigmoid sinus diverticulum (SSD), on hemodynamics in venous pulsatile tinnitus (PT) patients have not been established. The aim of this study was to evaluate the effects of SSWD, TSS, and SSD on the hemodynamics of transverse‐sigmoid sinus in venous PT patients. This was a prospective study with 44 venous PT patients and 12 healthy controls. A 3 T/four‐dimensional (4D) flow magnetic resonance imaging with fast field echo was used. Computed tomography arteriography/venography was used to assess ipsilateral SSWD, TSS, and SSD. Maximum velocity (Vmax), average velocity (Vavg), and average flow (Flowavg) were measured. Blood flow patterns were independently assessed by three neuroradiologists. One‐way analysis of variance or Kruskal–Wallis test was also used. On the symptomatic side, all patients had SSWD, 33 patients had TSS, and 22 patients had SSD. Compared with healthy controls, patients with TSS, without TSS, with SSD, and without SSD all showed higher Vmax (all p < 0.050), Vavg (all p < 0.050), and Flowavg (all p < 0.050). Patients with TSS showed higher Vmax (p < 0.050) and Vavg (p < 0.050) than those without TSS, and no significant difference in Flowavg was found between the two groups (p = 0.408). No significant differences in Vmax, Vavg, and Flowavg were found between patients with and without SSD (all p = 1.000). Jet‐like flow in the stenosis and downstream of the stenosis was observed in all patients with TSS. Vortex in SSD was observed in 15 patients with SSD (68%). High blood velocity and flow may be characteristic markers of venous PT. SSWD may be a necessary condition for venous PT. TSS may further increase the blood velocity and form a jet‐like flow. SSD may be related to vortex formation but had no significant effect on blood velocity and flow. Level of Evidence 2 Technical Efficacy Stage 3

Transverse Sinus Stenosis in Venous Pulsatile Tinnitus Patients May Lead to Brain Perfusion and White Matter Changes

“…These findings confirm that TSS in venous PT patients may lead to pathological brain changes. Venous PT is related to abnormal hemodynamics caused by different morphological changes (Li et al, 2021), including TSS, sigmoid sinus dehiscence with and without diverticulum, and jugular bulb abnormality (Dong et al, 2015;Kao et al, 2017;Hewes et al, 2020). TSS is one of the most common morphological abnormalities of venous PT and a cause of venous PT.…”

“…Normally, the left and right transverse sinuses would reveal a score of 4, and the final CCS would show a score of 8. A transverse sinus is characterized as dominant if its largest cross-sectional area is greater than 150% of that of the smaller side ( Li et al, 2021 ).…”

Altered Neurovascular Coupling in Unilateral Pulsatile Tinnitus

“…In this study, 24 right PT patients and 25 age-and sex-matched normal controls (NCs) were included. All patients showed pulse-synchronous noise (Li et al, 2021a), and sigmoid sinus wall dehiscence was considered the key etiology of PT by DSA and CTA/V. The exclusion criteria for all patients and NCs included hearing loss, MRI contraindications, hyperacusis, neuropsychiatric diseases, and history of head trauma.…”

“…Sigmoid sinus wall anomalies are considered the most common and curable cause of PT (Dong et al, 2015;Mundada et al, 2015). Sounds and vibrations produced by abnormal hemodynamics in the venous sinus are perceived by the inner ear through the incomplete sinus wall (Li et al, 2021a). Sigmoid sinus wall reconstruction can effectively eliminate PT (Zhang et al, level-dependent (BOLD) signals in resting-state fMRI (Fox and Raichle, 2007).…”

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.…”