Andreas Pomschar MD, Presenter: Equipment support, MED-EL GmbH

Noam Alperin PhD, Abstract Co-Author: Stockholder, Alperin Noninvasive Diagnostics, Inc

Ruediger Paul Laubender MA, MPH, Abstract Co-Author: Nothing to Disclose

Inga Koerte MD, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Birgit Betina Ertl-Wagner MD, Abstract Co-Author: Scientific Advisory Board, Koninklijke Philips Electronics NV Consultant, Bracco Group Travel support, Siemens AG

MR-based quantitation of jugular venous flow has increasingly been in the focus of recent interest, especially since a correlation between jugular venous outflow patterns and multiple sclerosis had been postulated. We aimed to examine the potential influence of angulation of the neck in supine position on jugular venous drainage.

Eleven subjects (6 males 27y ±3,4; 5 females 25y ±2,8) were included and underwent pulse-triggered cine-phase contrast MR imaging of the neck at the height of C2 on a 3T MR scanner with a combined head- and neck-coil (Magnetom Verio, Siemens). Morphological T1-weighted sequences were performed to assess the craniocaudal angle of C2 to C7. Measurements were first performed in a neutral head position and in a randomized order, in flexion and hyperextension of the neck. A pulsatility based algorithm was used to segement and quantify the blood flow through the internal jugular veins (IJVs) and the vertebral and internal carotid arteries. IJV flow (IJVF) was calculated as percentage of the total cerebral blood flow (TCBF). For statistical analysis a Wilcoxon signed-rank test was performed.

Both for flexion and for hyperextension highly significant differences in IJVF were observed compared to the neutral head position (for flexion: p<0.003; -53% to 56%, mean 14.9%±34.5%; for hyperextension: p<0.04; -45% to 44%, mean 20.7%±24.8%). No significant differences were found comparing IJVF in flexion vs. hyperextension (p=0.65). Moreover, no significant differences were observed for TCBF between head positions. The angle of flexion to hyperextension ranged from 24°-49°, mean 40°±7.4°. C2-C7 angles for neutral positioning ranged from -2 to 50° (mean 22°±17°). No consistent correlation could be demonstrated between the flexion-/hyperextension angle and the degree of IJVF.

As jugular venous flow is significantly influenced by head positioning even in supine within a head coil, special care needs to be taken to achieve a consistent positioning of the head in MR studies of craniocervical venous flow. This has an important implication when interpreting data from imaging studies, e.g. of craniocervical venous flow in MS.

Neck angulation markedly influences IJVF quantitation in MRI. This need to be taken into account when interpreting imaging data of craniocervical venous flow, e.g. in MS.

Pomschar, A, Alperin, N, Laubender, R, Koerte, I, Reiser, M, Ertl-Wagner, B, Effect of Neck Angulation on the MR-based Quantitation of Jugular Venous Flow.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12037700.html