Estimation of Venous Sinus Pressure Drop in Patients with Idiopathic Intracranial Hypertension Using 4D-flow MRI

Overview

Journal Eur Radiol

Specialty Radiology

Date 2022 Oct 26

PMID 36287270

Authors

Yupeng Zhang

Chao Ma

Shikai Liang

Changxuan Li

Haoyu Zhu

Zhiye Li

Zhongrong Miao

Xu Tong

Kehui Dong

Chuhan Jiang

Binbin Sui

Dapeng Mo

Affiliations

Soon will be listed here.

Abstract

Objective: We aimed to explore a non-invasive estimate of pressure drop in patients who undergo venous sinus stenting to treat idiopathic intracranial hypertension (IIH).

Methods: This prospective study included 28 IIH patients scheduled for venous stenting. 4D-flow MRI was acquired 24-48 h before venous manometry. Manometry-obtained pressure drop (Mp) was dichotomized into low (Lp: 0-8 mmHg) and high (Hp: 8-30 mmHg) groups. Hemodynamic indices were compared between Lp and Hp. Trans-stenotic pressure drop was estimated by work-energy equation, simplified Bernoulli equation, vorticity magnitude, and velocity difference between inlet and outlet and was compared with Mp. Measurement agreement, correlation, and accuracy were evaluated using the κ coefficient, Pearson's r, and confusion matrix-derived accuracy.

Results: Among 28 patients (mean age 38.8 ± 12.7), 19 (67.9%) were female. Work-energy equation-estimated pressure drop (WEp) had strong correlation (r = 0.91, 95% confidence interval [CI]: 0.81-0.96, p < 0.001) and high agreement (intraclass correlation coefficient = 0.90, 95% CI: 0.78-0.95, p < 0.001) with Mp. WEp classified Lp and Hp with an accuracy of 0.96. The κ value between WEp and Mp was 0.92 (95% CI: 0.78-1.00). In the work-energy equation, the viscosity energy term (V) had the largest weights, and the ratio of V to the summation of the three energy terms was 0.93 ± 0.07. V had strong correlation with mVort (r = 0.93, 95% CI: 0.85-0.97, p < 0.001), and mean vorticity magnitude was significantly elevated in Hp compared to that in Lp (259.8 vs. 174.9 mL/s, p < 0.001).

Conclusion: Trans-stenotic pressure drop in IIH can be estimated using the work-energy equation with favorable accuracy.

Key Points: • Trans-stenotic pressure drop in patients with idiopathic intracranial hypertension can be estimated accurately with the work-energy equation using the 4D-flow MRI full velocity field. • Compared with traditional venous sinus manometry, the 4D-flow MRI-derived pressure drop is totally non-invasive and cost-saving. • 4D-flow MRI may help neurointerventionalist to select IIH patients suitable for venous sinus stenting.

Citing Articles

Enhanced T-cell activation and chemokine-associated function in CD14-positive cells from venous sinus blood in sub-acute cerebral venous sinus thrombosis.

Chang Y, Song Y, Zhu H, Zhang J, Fu X, Wang Y Front Cell Dev Biol. 2024; 12:1488005.

PMID: 39605979 PMC: 11599252. DOI: 10.3389/fcell.2024.1488005.

The hemodynamic and geometric characteristics of carotid artery atherosclerotic plaque formation.

Han N, Wang J, Ma Y, Ma L, Zheng Y, Fan F Quant Imaging Med Surg. 2024; 14(7):4348-4361.

PMID: 39022224 PMC: 11250319. DOI: 10.21037/qims-23-1827.

High-resolution magnetic resonance imaging-based radiomic features aid in selecting endovascular candidates among patients with cerebral venous sinus thrombosis.

Chang Y, Zhu H, Song Y, Tong X, Li X, Wang Y Thromb J. 2023; 21(1):116.

PMID: 37950211 PMC: 10636961. DOI: 10.1186/s12959-023-00558-4.

A prognostic nomogram based on log odds of positive lymph nodes to predict the overall survival in biliary neuroendocrine neoplasms (NENs) patients after surgery.

Jiang S, Yang F, Zhang L, Sang X, Lu X, Zheng Y J Endocrinol Invest. 2022; 45(12):2341-2351.

PMID: 35908009 DOI: 10.1007/s40618-022-01874-8.

References

King J, Mitchell P, Thomson K, Tress B . Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology. 2002; 58(1):26-30. DOI: 10.1212/wnl.58.1.26. View

Liu K, Starke R, Durst C, Wang T, Ding D, Crowley R . Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. J Neurosurg. 2016; 127(5):1126-1133. DOI: 10.3171/2016.8.JNS16879. View

Patsalides A, Oliveira C, Wilcox J, Brown K, Grover K, Gobin Y . Venous sinus stenting lowers the intracranial pressure in patients with idiopathic intracranial hypertension. J Neurointerv Surg. 2018; 11(2):175-178. PMC: 6582809. DOI: 10.1136/neurintsurg-2018-014032. View

Raynald , Huo X, Yang H, Wang Z, Tong X, Li X . Characteristics and Outcomes of the Idiopathic Intracranial Hypertension Treatment in Intrinsic and Extrinsic Stenosis: A Single-Center Experience in China. Neurol Ther. 2021; 10(2):1029-1044. PMC: 8571462. DOI: 10.1007/s40120-021-00281-0. View

Nicholson P, Brinjikji W, Radovanovic I, Hilditch C, Tsang A, Krings T . Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis. J Neurointerv Surg. 2018; 11(4):380-385. DOI: 10.1136/neurintsurg-2018-014172. View

Fargen K, Liu K, Garner R, Greeneway G, Wolfe S, Crowley R . Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting. J Neurointerv Surg. 2018; 10(12):1203-1208. DOI: 10.1136/neurintsurg-2018-014042. View

Riggeal B, Bruce B, Saindane A, Ridha M, Kelly L, Newman N . Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology. 2012; 80(3):289-95. PMC: 3589184. DOI: 10.1212/WNL.0b013e31827debd6. View

Horev A, Lorber D, Vardi-Dvash N, Zlotnik Y, Biederko R, Ifergane G . A Comparison Between Pressure Wire and Microcatheter Measurements for Evaluating the Cerebral Venous Pressure Gradient. Front Neurol. 2021; 12:711870. PMC: 8554017. DOI: 10.3389/fneur.2021.711870. View

Ha H, Kvitting J, Dyverfeldt P, Ebbers T . Validation of pressure drop assessment using 4D flow MRI-based turbulence production in various shapes of aortic stenoses. Magn Reson Med. 2018; 81(2):893-906. DOI: 10.1002/mrm.27437. View

10.

Adriaans B, Westenberg J, van Cauteren Y, Gerretsen S, Elbaz M, Bekkers S . Clinical assessment of aortic valve stenosis: Comparison between 4D flow MRI and transthoracic echocardiography. J Magn Reson Imaging. 2019; 51(2):472-480. PMC: 7004028. DOI: 10.1002/jmri.26847. View

11.

Rivera-Rivera L, Johnson K, Turski P, Wieben O . Pressure Mapping and Hemodynamic Assessment of Intracranial Dural Sinuses and Dural Arteriovenous Fistulas with 4D Flow MRI. AJNR Am J Neuroradiol. 2017; 39(3):485-487. PMC: 6013315. DOI: 10.3174/ajnr.A5494. View

12.

Vali A, Aristova M, Vakil P, Abdalla R, Prabhakaran S, Markl M . Semi-automated analysis of 4D flow MRI to assess the hemodynamic impact of intracranial atherosclerotic disease. Magn Reson Med. 2019; 82(2):749-762. PMC: 6510639. DOI: 10.1002/mrm.27747. View

13.

Sekine T, Murai Y, Orita E, Ando T, Takagi R, Amano Y . Cross-Comparison of 4-Dimensional Flow Magnetic Resonance Imaging and Intraoperative Middle Cerebral Artery Pressure Measurements Before and After Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery. Neurosurgery. 2021; 89(5):909-916. DOI: 10.1093/neuros/nyab305. View

14.

Ding H, Zhao P, Lv H, Li X, Qiu X, Zeng R . Correlation Between Trans-Stenotic Blood Flow Velocity Differences and the Cerebral Venous Pressure Gradient in Transverse Sinus Stenosis: A Prospective 4-Dimensional Flow Magnetic Resonance Imaging Study. Neurosurgery. 2021; 89(4):549-556. PMC: 8440065. DOI: 10.1093/neuros/nyab222. View

15.

Donati F, Figueroa C, Smith N, Lamata P, Nordsletten D . Non-invasive pressure difference estimation from PC-MRI using the work-energy equation. Med Image Anal. 2015; 26(1):159-72. PMC: 4686008. DOI: 10.1016/j.media.2015.08.012. View

16.

Bateman A, Bateman G, Barber T . The relationship between cerebral blood flow and venous sinus pressure: can hyperemia induce idiopathic intracranial hypertension?. Fluids Barriers CNS. 2021; 18(1):5. PMC: 7860203. DOI: 10.1186/s12987-021-00239-2. View

17.

Bateman G, Siddique S . Cerebrospinal fluid absorption block at the vertex in chronic hydrocephalus: obstructed arachnoid granulations or elevated venous pressure?. Fluids Barriers CNS. 2014; 11:11. PMC: 4045963. DOI: 10.1186/2045-8118-11-11. View

18.

Demirkiran A, van Ooij P, Westenberg J, Hofman M, van Assen H, Schoonmade L . Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Eur Heart J Cardiovasc Imaging. 2021; 23(2):154-165. PMC: 8787996. DOI: 10.1093/ehjci/jeab112. View

19.

Mondejar V, Patsalides A . The Role of Arachnoid Granulations and the Glymphatic System in the Pathophysiology of Idiopathic Intracranial Hypertension. Curr Neurol Neurosci Rep. 2020; 20(7):20. DOI: 10.1007/s11910-020-01044-4. View

20.

Watane G, Patel B, Brown D, Taheri M . The Significance of Arachnoid Granulation in Patients With Idiopathic Intracranial Hypertension. J Comput Assist Tomogr. 2017; 42(2):282-285. DOI: 10.1097/RCT.0000000000000668. View