Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
LetterLetter

Unclear Value of Positional MR Angiography in Evaluating Cerebral Venous Outflow Hemodynamics

K. Dolic, K. Marr and R. Zivadinov
American Journal of Neuroradiology February 2012, 33 (2) E30; DOI: https://doi.org/10.3174/ajnr.A2991
K. Dolic
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
K. Marr
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
R. Zivadinov
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • References
  • PDF
Loading

We read with interest the article entitled “Positional Venous MR Angiography: An Operator-Independent Tool to Evaluate Cerebral Venous Outflow Hemodynamics,” originally published in the American Journal of Neuroradiology on-line on November 3, 2011.1

We believe that the authors did not consult relevant references previously reporting some of the key issues investigated by their study; the authors state that strictures of the jugular veins are common in healthy subjects at the level of the craniocervical junction in the supine position, which has already been noticed in previous work.2–4 In these studies, a high incidence of venous stenoses at the level of the lateral mass of the atlas (C1) and at the level of the inferior thyroid gland (C6/C7), in a cohort of healthy subjects and patients with multiple sclerosis (MS), was a physiologic finding (mostly due to compression of the adjacent structures) on the basis of the test-retest reproducibility results.4 It was reported by Niggemann et al1 that criterion 3 on Doppler sonography5 represents a “proximal (superior) stricture of the IJV [internal jugular vein],” whereas criterion 3 referred to the “high resolution B-mode evidence of proximal IJV stenoses.” The term “proximal” refers to relationship to the heart, indicating that stenosis is considered at the level of the thyroid or lower IJV area, not the upper craniocervical junction area.

Furthermore, the authors compared the IJV strictures in the supine-versus-upright position, which is not possible because in the supine position, the main venous extracranial outflow is through IJVs, so the signal-intensity flow in the IJVs in the upright position is very low or absent. This makes reliable determination of vein morphology changes difficult.5 On the basis of their results, which probably represent physiologic findings,2–4 they make a conclusion regarding the validity of the use of MR venography stenosis findings as a criterion for detection of chronic cerebrospinal venous insufficiency. In our opinion, this is an erroneous and misleading statement because previous reproducibility studies have shown that stenoses at the reported levels of C1/C6/C7 present with high variability in both patients with MS and healthy controls.4

Although the authors mentioned briefly that veins are prone to collapse, they do not discuss this in light of their findings, especially with respect to change toward the upright position, as previously described.2–4 In addition, by using only the 2D time-of-flight technique, they were not able to alleviate some of the usual MR venography artifacts and provide more detailed flow information. It was previously reported that assessment of reflux into the venous system by MR venography is not reliable even at 3T.2–4 In addition, criterion 1 on Doppler sonography5 represents reflux in the supine and upright position, not the supine or upright position, as reported by the authors. Also, the low strength of their MR imaging machine, 0.6T, and thicker sections used, 3.5 mm, which led to poor contrast and spatial resolution in comparison with standard MR imaging devices with 1.5–3T strength and section thicknesses of 1.5 mm, could have influenced their results considerably.

References

  1. 1.↵
    1. Niggemann P,
    2. Seifert M,
    3. Förg A,
    4. et al.
    Positional Venous MR Angiography: An Operator-Independent Tool to Evaluate Cerebral Venous Outflow Hemodynamics. AJNR Am J Neuroradiol 2011;33:246–51
  2. 2.↵
    1. Hojnacki D,
    2. Zamboni P,
    3. Lopez-Soriano A,
    4. 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 Angiol 2010;29:127–39
    PubMed
  3. 3.↵
    1. Zivadinov R,
    2. Galeotti R,
    3. Hojnacki D,
    4. et al.
    Value of MR venography for detection of internal jugular vein anomalies in multiple sclerosis: a pilot longitudinal study. AJNR Am J Neuroradiol 2011;77:138–44
  4. 4.↵
    1. Zivadinov R,
    2. Lopez-Soriano A,
    3. Weinstock-Guttman B,
    4. et al.
    Use of MR venography for characterization of the extracranial venous system in patients with multiple sclerosis and healthy control subjects. Radiology 2011;258:562–70
    CrossRefPubMed
  5. 5.↵
    1. Zamboni P,
    2. Galeotti R,
    3. Menegatti E,
    4. et al.
    Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2009;80:392–99
    Abstract/FREE Full Text
  • © 2012 by American Journal of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 33 (2)
American Journal of Neuroradiology
Vol. 33, Issue 2
1 Feb 2012
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Unclear Value of Positional MR Angiography in Evaluating Cerebral Venous Outflow Hemodynamics
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Unclear Value of Positional MR Angiography in Evaluating Cerebral Venous Outflow Hemodynamics
K. Dolic, K. Marr, R. Zivadinov
American Journal of Neuroradiology Feb 2012, 33 (2) E30; DOI: 10.3174/ajnr.A2991

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Unclear Value of Positional MR Angiography in Evaluating Cerebral Venous Outflow Hemodynamics
K. Dolic, K. Marr, R. Zivadinov
American Journal of Neuroradiology Feb 2012, 33 (2) E30; DOI: 10.3174/ajnr.A2991
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • References
  • Info & Metrics
  • References
  • PDF

Related Articles

  • Reply:
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Reply:
  • The Complementary Role of CT Perfusion and Transcranial Doppler in the Assessment of Delayed Cerebral Ischemia after Aneurysmal SAH
  • Dilator-Dotter Technique for Acute Ischemic Stroke: Further Applications in the Vertebral Arteries
Show more Letters

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2021 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2022 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire