The Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Clin Neurosci. 2022 Apr;98:6-10. doi: 10.1016/j.jocn.2022.01.024. Epub 2022 Jan 31.
The incidence and effects of stenosis of the cerebral venous system are poorly understood. When noninvasive computed tomography venography (CTV) of the head and neck suggests complete internal jugular vein (IJV) occlusion, invasive catheter-directed venography can discordantly show venous patency. We compared CTV vs digital subtraction venography (DSV) in the evaluation of patency/occlusion in the suspected IJV and contralateral IJV. We queried the venous intervention database of our U.S. academic tertiary-care hospital to identify patients with complete or near-complete IJV occlusion per CTV from March 1, 2019 to March 1, 2020. We included patients with both noninvasive and invasive imaging of the target segment and the contralateral IJV. Four patients had suspected occlusion of the IJV at the skull base. Invasive catheter-directed venography consisted of DSV to assess direction of flow and vessel caliber, as well as manometry proximal and distal to areas of suspected stenosis. DSV showed patency in all 4 IJVs for which CTV had shown suspected occlusions. CTV findings of the contralateral IJVs were patency (n = 2), moderate stenosis (n = 1), and severe/critical stenosis (n = 1). Contralateral IJV caliber, measured by DSV, was concordant with CTV findings. Median mean-pressure gradients across the apparent occlusion and contralateral segments were 1 (range, 1-4) mmHg and 0 (range, 0-5) mmHg, respectively. Although noninvasive CTV may suggest absence of or attenuated flow within the IJV, this technique may be insufficient to establish complete occlusion. Catheter-directed venography can be used to evaluate patency, vessel caliber, and mean-pressure gradient.
大脑静脉系统狭窄的发生率和影响尚不清楚。当头部和颈部的无创计算机断层静脉造影（CTV）提示完全性颈内静脉（IJV）闭塞时，有创导管定向静脉造影可能会显示出不一致的静脉通畅性。我们比较了 CTV 与数字减影静脉造影（DSV）在评估疑似 IJV 和对侧 IJV 通畅性/闭塞中的作用。我们在美国学术型三级保健医院的静脉介入数据库中查询了 2019 年 3 月 1 日至 2020 年 3 月 1 日期间根据 CTV 检查结果为完全性或接近完全性 IJV 闭塞的患者。我们纳入了接受目标节段和对侧 IJV 的无创和有创影像学检查的患者。有 4 例患者在颅底处疑似 IJV 闭塞。有创导管定向静脉造影包括 DSV 以评估血流方向和血管口径，以及可疑狭窄部位近端和远端的测压。DSV 显示 CTV 显示疑似闭塞的 4 例 IJV 均通畅。CTV 对侧 IJV 的结果为通畅（n=2）、中度狭窄（n=1）和重度/临界狭窄（n=1）。DSV 测量的对侧 IJV 口径与 CTV 检查结果一致。跨疑似闭塞段和对侧段的平均压力梯度分别为 1mmHg（范围，1-4mmHg）和 0mmHg（范围，0-5mmHg）。尽管无创 CTV 可能提示 IJV 内无血流或血流减弱，但该技术可能不足以确定完全闭塞。导管定向静脉造影可用于评估通畅性、血管口径和平均压力梯度。
