Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse

Abstract

Assessment of cerebral venous return is growing interest for potential application in clinical practice. Doppler ultrasound (DUS) was used as a screening tool. However, three meta-analyses of qualitative DUS protocol demonstrate a big heterogeneity among studies. In an attempt to improve accuracy, several authors alternatively measured the flow rate, based on the product of the time average velocity with the cross-sectional area (CSA). However, also the quantification protocols lacked of the necessary accuracy. The reasons are as follows: (a) automatic measurement of the CSA assimilates the jugular to a circle, while it is elliptical; (b) the use of just a single CSA value in a pulsatile vessel is inaccurate; (c) time average velocity assessment can be applied only in laminar flow. Finally, the tutorial describes alternative ultrasound calculation of flow based on the Womersley method, which takes into account the variation of the jugular CSA overtime. In the near future, it will be possible to synchronize the electrocardiogram with the brain inflow (carotid distension wave) and with the outflow (jugular venous pulse) in order to nicely have a noninvasive ultrasound picture of the brain-heart axis. US jugular venous pulse may have potential use in neurovascular, neurocognitive, neurosensorial, and neurodegenerative disorders.

Brachiocephalic Vessels Ultrasound Index of Arteriovenous Ratio (IAVR) and Headache as a Diagnostic Tool for Intracranial Venous Stasis in Arterial/Venous Ischemic Stroke’s Differentiation

“…It is noteworthy that the use of non-invasive (including ultrasound) techniques in the AHA/ASA 2018 recommendations is considered preferable in cases where the subsequent implementation of mechanical thromboextraction is not implied, while the use of multimodal (using MSCT and MRI) approach to the diagnosis of stroke is not recommended due to a possible delay in the decision to perform thrombolytic therapy (Class III, level of evidence B, randomized trials is no exist) [30]. Assessment of velocity parameters in the Galen vein and Rosenthal veins during transcranial scanning is an additional indirect sign of intracranial venous stasis, but the use of the method is limited by the absence of an acoustic window according to various data in 10-20% of cases [31][32][33]. The use of ultrasonic IAVR (within the protocol of color duplex scanning of brachiocephalic vessels), as well as the assessment of headache intensity according to the visual analogue scale in the developed model, improve the quality of early diagnosis of acute ischemic stroke and get the predicted likelihood of a patient having a venous stroke without the need for the cumbersome formula presented above.…”

Magnetic Resonance Imaging of Internal Jugular Veins in Multiple Sclerosis: Interobserver Agreement and Comparison with Doppler Ultrasound Examination

“…4). 19,20 Also, the meaning of breathing variation is unknown. Dolic et al 14 assessed the US and MRV in their study and found US to be more sensitive than MRV in detecting intraluminal changes in IJVs, whereas MRV was more sensitive in showing collaterals.…”

Clinical Classification and Collateral Circulation in Chronic Cerebrospinal Venous Insufficiency

“…Although, the repeatability and accuracy for measuring the diameter and flow velocity will be impacted by multiple factors. The internal vertebral vein in the spinal canal is difficult to detect and estimate quantitatively by ultrasound as it is surrounded by cervical vertebrae and its shape is irregular (34). CE-MRV can estimate the location of each vein spatially and comprehensively, but it will amplify the severity of IJVS.…”