Abstract
The transcondylar approach is a new and used for detection of chronic cerebro-spinal venous insufficiency (CCSVI) and intracranial venous reflux in patients with multiple sclerosis. The aim of this study was to assess the ability of native and contrast enhanced (CE-) transcranial color-coded duplex sonography (TCCS) to detect flow and reflux in deep cerebral veins and intracranial venous sinuses from transcondylar and transtemporal approaches. Brain magnetic resonance imaging and TCCS from transtemporal and transcondylar approaches using the new technology - Fusion Imaging - in 8 volunteers and 5 patients with multiple sclerosis. Using TCCS and CE-TCCS, the arteries of the circle of Willis could be detected from the transtemporal approach in 13/13 subjects in both examinations, while detection of the venous system was possible in 7/13 and 9/13 subjects, respectively. However, the arteries of the circle of Willis and venous system were detected through the transcondylar approach in only 5/13 (P=0.041) and 1/13 (P=0.031) subjects using TCCS, and in 12/13 (P=0.921) and 7/13 (P=0.687) subjects using CE-TCCS, respectively. The results reveal that the TCCS transcondylar approach has serious limitations for the standard detection of intracranial venous reflux.
Highlights
Chronic cerebro-spinal venous insufficiency (CCSVI) is a vascular syndrome first defined by Zamboni et al, who assumed its association with multiple sclerosis (MS)
Magnetic resonance image acquisition The Virtual Navigator registration procedure required for synchronization between US data and the magnetic resonance imaging (MRI) volume dataset consists of two phases: first an anatomical marker registration, considering a subject’s external facial landmarks, a fine tuning to refine the synchronization between the two imaging modalities using internal cerebral anatomical landmarks
Fusion imaging technology is able to help with the correct detection of venous blood flow due to real-time fusion of MRI and transcranial color-coded duplex sonography (TCCS) images, where the venous system was imaged using brain MRI and venous blood flow was encoded to the MRI image using the color Doppler mode[8,11,12]
Summary
Chronic cerebro-spinal venous insufficiency (CCSVI) is a vascular syndrome first defined by Zamboni et al, who assumed its association with multiple sclerosis (MS) (ref.[1,2]). This hypothesis has been questioned in several studies and requires confirmation and further investigation[3]. The CCSVI theory is based on the fact that deoxygenated blood flow from the brain and spinal veins is slowed down or blocked on its way back to the heart This condition arises mainly from blockage in the internal jugular (IJV) and/or azygous veins[1]. A reflux, i.e. venous blood flow to the brain, can occur during specific respiration phases, either in the IJVs, the vertebral veins (VVs) or in intracranial veins (deep cerebral veins – DCVs, sinuses and veins draining subcortical gray matter – VDSGM) (ref.[1]).
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Schedule a callMore From: Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
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