Volume 51, Issue 1 pp. 205-217

Original Research

Hemodynamics of cerebral veins analyzed by 2d and 4d flow mri and ultrasound in healthy volunteers and patients with multiple sclerosis

Florian F. Schuchardt MD,

Corresponding Author

Florian F. Schuchardt MD

[email protected]

orcid.org/0000-0002-2549-3089

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

Address reprint requests to: F.F.S., Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Breisacher Straβe 64, 79106 Freiburg, Germany. E-mail: [email protected]Search for more papers by this author

Christoph P. Kaller PhD,

Christoph P. Kaller PhD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

Department of Neuroradiology, Medical Center, University of Freiburg, Germany

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Christoph Strecker MD,

Christoph Strecker MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

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Johann Lambeck MD,

Johann Lambeck MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

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Thomas Wehrum MD,

Thomas Wehrum MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

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Anja Hennemuth PhD,

Anja Hennemuth PhD

Fraunhofer Institute for Medical Image Computing MEVIS, Berlin, Germany

Institute for Cardiovascular Computer-assisted Medicine, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Germany

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Constantinos Anastasopoulos MD,

Constantinos Anastasopoulos MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neuroradiology, Medical Center, University of Freiburg, Germany

Department of Radiology, University of Basel, Basel, Switzerland

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Irina Mader MD,

Irina Mader MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neuroradiology, Medical Center, University of Freiburg, Germany

Department of Radiology, Schön-Klinik, Vogtareuth, Germany

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Andreas Harloff MD,

Andreas Harloff MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

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Florian F. Schuchardt MD,

Corresponding Author

Florian F. Schuchardt MD

[email protected]

orcid.org/0000-0002-2549-3089

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

Christoph P. Kaller PhD,

Christoph P. Kaller PhD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

Department of Neuroradiology, Medical Center, University of Freiburg, Germany

Search for more papers by this author

Christoph Strecker MD,

Christoph Strecker MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

Search for more papers by this author

Johann Lambeck MD,

Johann Lambeck MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

Search for more papers by this author

Thomas Wehrum MD,

Thomas Wehrum MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

Search for more papers by this author

Anja Hennemuth PhD,

Anja Hennemuth PhD

Fraunhofer Institute for Medical Image Computing MEVIS, Berlin, Germany

Institute for Cardiovascular Computer-assisted Medicine, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Germany

Search for more papers by this author

Constantinos Anastasopoulos MD,

Constantinos Anastasopoulos MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neuroradiology, Medical Center, University of Freiburg, Germany

Department of Radiology, University of Basel, Basel, Switzerland

Search for more papers by this author

Irina Mader MD,

Irina Mader MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neuroradiology, Medical Center, University of Freiburg, Germany

Department of Radiology, Schön-Klinik, Vogtareuth, Germany

Search for more papers by this author

Andreas Harloff MD,

Andreas Harloff MD

Faculty of Medicine, University of Freiburg, Germany

Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany

Search for more papers by this author

First published: 17 May 2019

https://doi.org/10.1002/jmri.26782

Citations: 13

Contract grant sponsor: Forschungskommission, Medical Faculty, Albert-Ludwigs-University Freiburg (to F.H.); Contract grant sponsor: BrainLinks-BrainTools Cluster of Excellence; Contract grant number: DFG EXC 1086 (to C.P.K.); Contract grant sponsor: Deutsche Forschungsgemeinschaft Contract grant number: DFG HA 5399/3-1, FR 2795/2-1 (to Anja H., A.H.)

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Abstract

Background

Hemodynamic alterations of extracranial veins are considered an etiologic factor in multiple sclerosis (MS). However, ultrasound and MRI studies could not confirm a pathophysiological link. Because of technical challenges using standard diagnostics, information about the involvement of superficial intracranial veins in proximity to the affected brain in MS is scarce.

Purpose

To comprehensively investigate the hemodynamics of intracranial veins and of the venous outflow tract in MS patients and controls.

Study Type

Prospective.

Population

Twenty-eight patients with relapsing-remitting MS (EDSS1.9 ± 1.1; range 0–3) and 41 healthy controls.

Field Strength/Sequence

3T/2D phase-contrast and time-resolved 4D flow MRI, extra- and transcranial sonography.

Assessment

Hemodynamics within the superficial and deep intracranial venous system and outflow tract including the internal, basal, and great cerebral vein, straight, superior sagittal, and transverse sinuses, internal jugular and vertebral veins. Sonography adhered to the chronic cerebrospinal venous insufficiency (CCSVI) criteria.

Statistical Tests

Multivariate repeated measure analysis of variance, Student's two-sample t-test, chi-square, Fisher's exact test; separate analysis of the entire cohort and 32 age- and sex-matched participants.

Results

Multi- and univariate main effects of the factor group (MS patient vs. control) and its interactions with the factor vessel position (lower flow within dorsal superior sagittal sinus in MS, 3 ± 1 ml/s vs. 3.8 ± 1 ml/s; P < 0.05) in the uncontrolled cohort were attributable to age-related differences. Age- and sex-matched pairs showed a different velocity gradient in a single segment within the deep cerebral veins (great cerebral vein, vena cerebri magna [VCM] 7.6 ± 1.7 cm/s; straight sinus [StS] 10.5 ± 2.2 cm/s vs. volunteers: VCM 9.2 ± 2.3 cm/s; StS 10.2 ± 2.3 cm/s; P = 0.01), reaching comparable velocities instantaneously downstream. Sonography was not statistically different between groups.

Data Conclusion

Consistent with previous studies focusing on extracranial hemodynamics, our comprehensive analysis of intracerebral venous blood flow did not reveal relevant differences between MS patients and controls.

Level of Evidence 1.

Technical Efficacy Stage 3. J. Magn. Reson. Imaging 2020;51:205–217.

Supporting Information

Filename	Description
jmri26782-sup-0001-VideoS1.mp4MPEG-4 video, 3.4 MB	Supplementary Video 1 Time-resolved 3D blood-flow of intracranial veins is visualized in a female MS patient. Flow trajectories are color-coded, with blue representing slow and red representing higher blood flow velocities. Please note the constant flow pattern with continuously forward moving flow trajectories. These are comparable to the visualization in video 2 of the matched control. Visualization presents a birds view onto the intracranial veins (contrary to the radiological convention). Note the visualization of the internal cerebral vein in this patient, while time-resolved 3D blood-flow of the basal vein of Rosenthal was not demonstrable with the current spatial resolution of this MRI sequence.
jmri26782-sup-0002-VideoS2.mp4MPEG-4 video, 2.7 MB	Supplementary Video 2 Time-resolved 3D blood-flow is visualized in intracranial veins of a female control (age- and sex-matched pair no. 2). Flow trajectories are color-coded, with blue representing slow and red representing higher blood flow velocities. Note the constant flow pattern with continuously forward moving flow trajectories. These are comparable to the visualization in video 1, showing the patient among the matched twins.
jmri26782-sup-0003-TableS1.docxWord 2007 document , 28.8 KB	Supplementary Table: Repeated measures multivariate analysis of variance (MANOVA) of 2D phase-contrast MRI. Results of the multivariate analysis of main effects and interactions and subsequent univariate analysis of variables with significant multivariate results presented for 2D phase-contrast MRI. Where appropriate, the results are separately shown for velocity and flow. - = not applicable due to non-significant multivariate result; n.a. = not applicable due to low number of participants. ICV = internal cerebral veins; BVR = basal veins of Rosenthal. F = result of F-test, HC = healthy control; MS = MS patient.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Citing Literature

Volume51, Issue1

January 2020

Pages 205-217

Hemodynamics of cerebral veins analyzed by 2d and 4d flow mri and ultrasound in healthy volunteers and patients with multiple sclerosis

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Supporting Information

References

Citing Literature

References

Information

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Hemodynamics of cerebral veins analyzed by 2d and 4d flow mri and ultrasound in healthy volunteers and patients with multiple sclerosis

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Supporting Information

References

Citing Literature

References

Related

Information