Transcranial Color-Coded Duplex Sonography of Intracranial Veins and Sinuses in Adults

Abstract

Background and Purpose-Transcranial color-coded duplex sonography (TCCS) of intracranial veins and sinuses in adults is a new, emerging application of ultrasonographic imaging. This study reports a standardized examination protocol for venous TCCS and provides reference data for clinical application. Methods-In 130 healthy volunteers (mean age, 45.9Ϯ16.9 years; range, 14 to 77 years) the intracranial venous system was examined using frequency-based transtemporal TCCS. Identification rate, blood flow velocity , resistance index, and systolic/diastolic ratio were recorded for each examined venous vessel. Results-Intracranial veins and sinuses show a low pulsatile forward flow with maximal systolic blood flow velocity up to 20 cm/s. Significant side differences of blood flow velocity in the paired venous structures could not be detected. Venous flow velocities decreased with age, whereas resistance indices and systolic/diastolic ratios increased. Women showed higher flow velocities than men. Mean identification rates for all age groups ranged from 70% to 90% for the deep middle cerebral vein, the basal cerebral vein, and the great cerebral vein of Galen. The straight sinus, the transverse sinus, and the rostral part of the superior sagittal sinus could be detected in 55% to 70% of cases. Detection rates were dependent on age and decreased as age increased. Conclusions-Venous TCCS can reliably image a significant part of the cerebral venous system. This method can provide information on venous hemodynamics in normal subjects and pathological cases.

New Criteria Reduce Inter-Observer Variability in Chronic Cerebrospinal Venous Insufficiency: A Case Control Study

“…All veins [both IJVs and VVs, deep cerebral veins (DCVs)] were evaluated in the laterocervical area of the neck and through the transtemporal and transoccipital windows, using a large amount of gel to assure perfect coupling of the transducer, according to the screen- ing protocols for CCSVI with ultrasound and other studies. 10,40 In the evaluation of DCVs (vein of Rosenthal, vein of Galen, transverse sinus, straight sinus and internal cerebral vein) the problems related to a Doppler angle of insonation close to 90° were solved by using a multi-angle Doppler system such as the Quality Doppler Processing technology (QDP). QDP helps in detecting the blood flow direction within the cerebral veins.…”

Changing Concepts of Cerebrospinal Fluid Hydrodynamics: Role of Phase-Contrast Magnetic Resonance Imaging and Implications for Cerebral Microvascular Disease

“…30,31 The effect of this is that the systolic pressure wave is dissipated by the formation of CSF and venous pulsatility and largely bypasses the cerebral circulation. In addition, the elastic artery walls absorb part of the energy of the systolic arterial pulse wave, which is then released during diastole to maintain constant capillary flow.…”

Cerebral Veins-Why Functional MR Imaging is Worth the Trouble

“…9 2D high-resolution sonography is ideally suited to study blood flow in extra-and intracranial veins. 10,11 It is limited due to the 2-dimensionality and operator dependency and requires a high level of experience and an adequate bone window for transcranial Doppler sonography. However, sonography allows a very accurate visualization and quantification of venous blood flow in both a supine or upright position and during free breathing or a Valsalva maneuver.…”

“…MR imaging provides the unique advantage of visualizing and quantifying blood flow in the superior sagittal sinus and in the superficial bridging veins that are hardly or not at all assessable by sonography due to the lack of a sufficient bone window. 10 Ac-cordingly, little is known about physiologic flow or about pathologic changes at these sites in patients with acute brain edema, traumatic brain injury, sinus thrombosis, or idiopathic intracranial hypertension. A comparison with sonography in reliably accessible vessels such as the transverse sinus 10 or with highresolution 2D phase-conventional angiography 8 as the reference method is a prerequisite before this MR imaging technique can be used in trials or in clinical routine.…”

“…10 Ac-cordingly, little is known about physiologic flow or about pathologic changes at these sites in patients with acute brain edema, traumatic brain injury, sinus thrombosis, or idiopathic intracranial hypertension. A comparison with sonography in reliably accessible vessels such as the transverse sinus 10 or with highresolution 2D phase-conventional angiography 8 as the reference method is a prerequisite before this MR imaging technique can be used in trials or in clinical routine. In particular, accurate quantification of blood flow in small cerebral veins (ie, straight sinus, internal cerebral veins, basal veins, and the vein of Galen) is challenging and requires a spatial resolution of Ͻ0.25 mm 3 .…”