RT Journal Article
SR Electronic
T1 MR Venous Flow in Sigmoid Sinus Diverticulum
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 2108
OP 2113
DO 10.3174/ajnr.A5833
VO 39
IS 11
A1 M.R. Amans
A1 H. Haraldsson
A1 E. Kao
A1 S. Kefayati
A1 K. Meisel
A1 R. Khangura
A1 J. Leach
A1 N.D. Jani
A1 F. Faraji
A1 M. Ballweber
A1 W. Smith
A1 D. Saloner
YR 2018
UL http://www.ajnr.org/content/39/11/2108.abstract
AB BACKGROUND AND PURPOSE: Case reports demonstrate that coiling of a sigmoid sinus diverticulum can treat pulsatile tinnitus. We hypothesized that MR imaging 4D flow and computational fluid dynamics would reveal distinct blood flow patterns in the venous outflow tract in these patients.MATERIALS AND METHODS: Patients with pulsatile tinnitus of suspected venous etiology underwent MR imaging at 3T, using venous phase contrast-enhanced MR angiography, 4D flow, and 2D phase contrast. The contrast-enhanced MRA contours were evaluated to determine the presence and extent of a sigmoid sinus diverticulum. Computational fluid dynamics analysis was performed using the 4D flow inlet flow and the luminal contours from contrast-enhanced MRA as boundary conditions. In addition, computational fluid dynamics was performed for the expected post treatment conditions by smoothing the venous geometry to exclude the sigmoid sinus diverticulum from the anatomic boundary conditions. Streamlines were generated from the 4D flow and computational fluid dynamics velocity maps, and flow patterns were examined for the presence of rotational components.RESULTS: Twenty-five patients with pulsatile tinnitus of suspected venous etiology and 10 control subjects were enrolled. Five (20%) of the symptomatic subjects had sigmoid sinus diverticula, all associated with an upstream stenosis. In each of these patients, but none of the controls, a stenosis-related flow jet was directed toward the opening of the sigmoid sinus diverticulum with rotational flow patterns in the sigmoid sinus diverticulum and parent sigmoid sinus on both 4D flow and computational fluid dynamics.CONCLUSIONs: Consistent patterns of blood flow can be visualized in a sigmoid sinus diverticulum and the parent sinus using 4D flow and computational fluid dynamics. Strong components of rotational blood flow were seen in subjects with sigmoid sinus diverticula that were absent in controls.CFDcomputational fluid dynamics4DF4D flowPTpulsatile tinnitusSSDsigmoid sinus diverticulumSSIJsigmoid sinus and internal jugular veinUCSFUniversity of California, San Francisco