The aim of this study was to formulate an ultrasonic diagnostic criterion for stenosis in the J3 segment of internal jugular vein (IJV) and probe into the effects of stenosis in the J3 segment on intracranial pressure (ICP) and the cerebral drainage pattern.
Methods
Participants who exhibited narrowing in the J3 segment of IJV on neuroimaging and reported symptoms correlated with IJV stenosis (IJVS) were enlisted from Xuanwu Hospital. Clinical data were retrospectively amassed.
Results
A total of 163 subjects including 57 IJVS subjects and 106 control subjects were recruited. We unearthed an inverse relationship between the pressure gradient and the flow velocity. Flow velocity at or below 27.5 cm/s coincided with pressure gradient values of 4 mmHg or greater. There is no significant correlation between IJVS and ICP. Additionally, a linear correlation was identified between the bilateral flow volume in the J3 segment and ICP. Values exceeding 425 mL/min were indicative of intracranial hypertension. There was an increase in diameter, flow volume and flow velocity in the bilateral vertebral veins in participants with IJVS.
Conclusions
The J3 segment of IJV displays right dominance. Stenosis can be deduced when the flow velocity in the J3 segment is at or below 27.5 cm/s. Stenosis in the J3 segment yielded a diminished outflow in the IJV and an augmented outflow in the vertebral veins. When bilateral flow volume in the J3 segment exceeds 425 mL/min, it denotes intracranial hypertension.
HojnackiDZamboniPLopez-SorianoA, et al.Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls. Int Angiol2010; 29: 127–139.
2.
ScaliseFFarinaMManfrediM, et al.Assessment of jugular endovascular malformations in chronic cerebrospinal venous insufficiency: colour-Doppler scanning and catheter venography compared with intravascular ultrasound. Phlebology2013; 28: 409–417.
ZivadinovRChungC-P. Potential involvement of the extracranial venous system in central nervous system disorders and aging. BMC Med2013; 11: 260.
5.
BaiCWangZStoneC, et al.Pathogenesis and management in cerebrovenous outflow disorders. Aging Dis2021; 12: 203–222.
6.
ZhouDDingJAsmaroK, et al.Clinical characteristics and neuroimaging findings in internal jugular venous outflow disturbance. Thromb Haemost2019; 119: 308–318.
7.
HauserRAMatiasDRawlingsB. The ligamentous cervical instability etiology of human disease from the forward head-facedown lifestyle: emphasis on obstruction of fluid flow into and out of the brain. Front Neurol2024; 15: 1430390.
8.
HanKHuH-HChaoAC, et al.Transient global amnesia linked to impairment of brain venous drainage: an ultrasound investigation. Front Neurol2019; 10: 67.
9.
MatsuzonoKSuzukiMMiuraK, et al.Internal jugular vein velocity and spontaneous echo contrast correlate with Alzheimer’s disease and cognitive function. J Alzheimers Dis2021; 84: 787–796.
UtriainenDFengWEliasS, et al.Using magnetic resonance imaging as a means to study chronic cerebral spinal venous insufficiency in multiple sclerosis patients. Tech Vasc Intervent Radiol2012; 15: 101–112.
12.
TartièreDSeguinPJuhelC, et al.Estimation of the diameter and cross-sectional area of the internal jugular veins in adult patients. Crit Care2009; 13: R197.
13.
ZamboniPSisiniFMenegattiE, et al.An ultrasound model to calculate the brain blood outflow through collateral vessels: a pilot study. BMC Neurol2013; 13: 81.
14.
EnglandRWArunAVoslerPS, et al.Catheter-directed venography for evaluating internal jugular vein pseudo-occlusion. J Clin Neurosci2022; 98: 6–10.
15.
ZhouDMengRZhangX, et al.Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting. Eur J Neurol2017; 25: 365.
16.
PaolettiMGermaniGDe IccoR, et al.Intra- and extracranial MR venography: technical notes, clinical application, and imaging development. Behav Neurol2016; 2016: 2694504.
17.
ZaniewskiMKosteckiJKuczmikW, et al.Neck duplex Doppler ultrasound evaluation for assessing chronic cerebrospinal venous insufficiency in multiple sclerosis patients. Phlebology2012; 28: 24–31.
18.
ThibaultPLewisWNiblettS. Objective duplex ultrasound evaluation of the extracranial circulation in multiple sclerosis patients undergoing venoplasty of internal jugular vein stenoses: a pilot study. Phlebology2013; 30: 98–104.
19.
LiMSuCFanC, et al.Internal jugular vein stenosis induced by tortuous internal carotid artery compression: two case reports and literature review. J Int Med Res2019; 47: 3926–3933.
20.
LiMSunYChanCC, et al.Internal jugular vein stenosis associated with elongated styloid process: five case reports and literature review. BMC Neurol2019; 19: 112.
21.
ZamboniPGaleottiRSalviF, et al.Effects of venous angioplasty on cerebral lesions in multiple sclerosis: expanded analysis of the brave dreams double-blind, sham-controlled randomized trial. J Endovasc Ther2020; 27: 1526602819890110.
22.
GisolfJvan LieshoutJJvan HeusdenK, et al.Human cerebral venous outflow pathway depends on posture and central venous pressure. J Physiol2004; 560: 317–327.
23.
ZaniewskiMSimkaM. Biophysics of venous return from the brain from the perspective of the pathophysiology of chronic cerebrospinal venous insufficiency. Rev Recent Clin Trials2012; 7: 88–92.
24.
BosMJvan LoonRFHJHeywoodL, et al.Comparison of the diameter, cross-sectional area, and position of the left and right internal jugular vein and carotid artery in adults using ultrasound. J Clin Anesth2016; 32: 65–69.
25.
KarmonYZivadinovRWeinstock-GuttmanB, et al.Comparison of intravascular ultrasound with conventional venography for detection of extracranial venous abnormalities indicative of chronic cerebrospinal venous insufficiency. J Vasc Intervent Radiol2013; 24: 1487–1498.
26.
SclafaniSJA. Intravascular ultrasound in the diagnosis and treatment of chronic cerebrospinal venous insufficiency. Tech Vasc Intervent Radiol2012; 15: 131–143.
27.
WangZDingJBaiC, et al.Clinical classification and collateral circulation in chronic cerebrospinal venous insufficiency. Front Neurol2020; 11: 913.
28.
MitsuakiMDaisukeKKazuoA, et al.The cis-acting regulatory elements of immunoglobulin heavy chain gene involved in enhanced immunoglobulin production after lipopolysaccharide (LPS) stimulation. Mol Immunol1987; 24: 759–764.
29.
LiMGaoXRajahGB, et al.Styloidectomy and venous stenting for treatment of styloid-induced internal jugular vein stenosis: a case report and literature review. World Neurosurg2019; 130: 129–132.
30.
BonoFQuattroneA. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology2013; 81: 695.
31.
WoodallMNNguyenKDAlleyneCHJr., et al.Bilateral transverse sinus stenosis causing intracranial hypertension. BMJ Case Rep2013; 2013: bcr2013010513.
32.
KılıçTAkakınA. Anatomy of cerebral veins and sinuses. Frontiers of Neurology and Neuroscience. KARGER, 2007, pp. 4–15.
33.
DoeppFSchreiberSJvon MünsterT, et al.How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns. Neuroradiology2004; 46: 565–570.
34.
CanacNJalaleddiniKThorpeSG, et al.Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring. Fluids Barriers CNS2020; 17: 40.
35.
FoongLKZarringhalamMToghraieD, et al.Numerical study for blood rheology inside an artery: the effects of stenosis and radius on the flow behavior. Comput Methods Progr Biomed2020; 193: 105457.
36.
GaddaGTaibiASisiniF, et al.A new hemodynamic model for the study of cerebral venous outflow. Am J Physiol Heart Circ Physiol2015; 308: H217–H231.
