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Case series
Intracranial venous sinus stenosis: hemodynamic assessment with two-dimensional parametric parenchymal blood flow software on digital subtraction angiography
  1. Zayed Almadidy1,
  2. Denise Brunozzi1,
  3. Jessica Nelson2,
  4. John Baumgart2,
  5. Gursant Atwal1,
  6. Ali Alaraj, 1 Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA1,3
  1. 1Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
  2. 2Siemens Medical Solutions USA Inc, Malvern, Pennsylvania, USA
  3. 3Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Ali Alaraj, Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA; alaraj{at}uic.edu

Abstract

Objective Intracranial venous sinus stenosis (IVSS) is the most common finding associated with idiopathic intracranial hypertension. A pressure gradient >8–10 mm Hg across the stenosis is considered hemodynamically significant, and typically responds to endovascular stent treatment. Here we assess the venous hemodynamics with two-dimensional (2D) parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany) and its ability to predict significant IVSS.

Methods Patients with IVSS treated at our institution between 2013 and 2018 were retrospectively reviewed. Measurements of contrast transit time on DSA were calculated with 2D parametric parenchymal blood flow software. Values were obtained proximally and distally to the stenotic region. Venous Stenosis Index (VSI) was defined as the ratio of the area under the curve (AUC) in the pre-stenotic vessel to the AUC in the post-stenotic vessel. VSI was compared between the stenotic and control groups at baseline, and before and after stent deployment in the stenotic group. The accuracy of VSI was assessed using the non-parametric receiver operating characteristic (ROC) curve.

Results 11 patients with IVSS treated with venous stent deployment were included. Patients in the control group were similar in age, gender, and absence of major comorbidities. VSI in the IVSS group was significantly higher at baseline compared with the control group (1.42 vs 0.97, p=0.01). Area under the ROC was 0.82. After stent deployment, VSI decreased significantly compared with baseline (1.04 vs 1.42, p<0.01).

Conclusion 2D parametric parenchymal blood flow software is a useful tool which can accurately evaluate significant hemodynamic venous stenosis without intracranial catheterization, added radiation exposure, additional contrast injection, and periprocedural risks.

  • cerebral venous sinus stenosis
  • digital subtraction angiography
  • hemodynamics
  • idiopathic intracranial hypertension
  • parametric color coded image
  • syngo iFlow
  • two-dimensional parametric parenchymal blood flow software
  • transit time
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Footnotes

  • Contributors ZA: data collection, statistical analysis, and drafted the manuscript. DB: edited and revised the manuscript. JN: data collection. JB: data collection. GA: edited and revised the manuscript. AA: devised and supervised the project, and critically revised the manuscript.

  • Funding This study was funded by Siemens Healthineers.

  • Competing interests AA: MD research grant, NIH; consultant for Siemens and Cerenovus.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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