Validation of Jugular Venous Flow as an Index of Total Cerebral Blood Flow

Abstract

Values of total cerebral blood flow in man measured by the indicator dilution method are compared with values of total internal jugular venous flow measured by the thermal dilution method. Except in the case of an extremely labile cerebral hemodynamic state, the results agree within the accuracy of the two methods, suggesting that for the supine patient total internal jugular venous flow provides a good index of total cerebral flow. The relatively short measurement time associated with nondiffusible indicators (dye or thermal dilution) facilitates detection of transient changes in total CBF or differential jugular flow that would tend to be averaged out with diffusible indicator methods. A mathematical analysis of the potential errors in the computation of total flow using the average of bilateral jugular venous dilution curves from a unilateral internal carotid injection is presented. This error can be partially corrected if the ratio of flow in one internal jugular to total flow is known. An analysis of potential computational errors under nonsteady state flow conditions (change in flow during the period between alternate carotid injections) is presented. Such flow changes can effect substantial errors in the computation of individual hemispheric or internal jugular flow and smaller errors in the computation of total flow.

Estimation of Cerebral Blood Flow at Bedside by Continuous Jugular Thermodilution

“…An average of 2.7% (range 0-6.6%) of the blood in the jugular bulb is derived from extracerebral structures (Shenkin et aI., 1948). Wilson et al (1972) measured jugular blood flow on both sides by thermodilution and found a good agreement within 12-15% when compared with total cerebral blood flow measured by the dye di lution method. These results are in agreement with the study of Meyer et al (1963), in which internal jugular flow measured with an electromagnetic flowmeter and extrapolated to flow per unit of mass was compared with predicted values from the nitrous oxide method.…”

Validation of diffuse correlation spectroscopic measurement of cerebral blood flow using phase-encoded velocity mapping magnetic resonance imaging

“…31,32 Therefore, in normal function, the micro vascular CBF changes in the frontal cortex measured by DCS should represent similar changes throughout the brain and these micro vascular changes should also be reflected in the macro vascular changes in blood flow drainage in the jugular veins. 17,18 Naturally, this micro/macro agreement presumes the patient has a healthy brain with no regions of watershed or hypoxia that may cause the frontal cortex to be a poor representation of the whole brain. Further, all patients were studied under conditions of general anesthesia with mechanical ventilation and neuromuscular blockade.…”

“…These measures of flow in the jugular veins have been shown to agree strongly with other measures of cerebral blood flow. 17,18 However, while VENC MRI provides highquality, reliable blood flow data, these measurements must be carried out in an MRI scanner making them unsuitable for continuous monitoring. We find that relative changes of blood flow in the jugular veins and superior vena cava correlate strongly with relative changes in CBF measured with DCS.…”

Extrajugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound

“…The IJVs have been considered to present the most important pathway for venous blood returning from the brain. This assumption was based on angiographic studies and cerebral blood flow analyses with nitrous oxide, labeled erythrocytes, and thermodilution techniques (12,21,15,25), which were all performed in a supine body position. However, anatomic investigations as well as clinical observations in patients after bilateral radical neck dissection suggest coexisting IJV-independent alternative venous drainage pathways (9).…”