title: Functional and morphological criteria of internal jugular valve insufficiency as assessed by ultrasound.
abstract: OBJECTIVE
  Jugular venous valve insufficiency may play a role in different neurological diseases. This study describes the methodology to detect internal jugular valve insufficiency and establishes functional and morphological criteria to discriminate retrograde flow during valve closure from retro grade insufficiency flow.
  
  
  METHODS
  Valve closure was assessed in 100 valves (50 healthy volunteers). The valves were visualized in B-mode. During a pressure-controlled Valsalva maneuver, valve closure was monitored by color duplex. The duration and the peak velocity of retrograde flow were determined.
  
  
  RESULTS
  Backward flow during valve closure in competent valves was visually clearly discernible from a retrograde flow jet through insufficient valves. Insufficiency was found in 29% of valves. The duration of backward flow in competent valves was between 0.22 and 0.78 seconds (mean = 0.46 +/- 0.14 seconds on Doppler measurements) and in insufficient valves between 1.23 and 6.15 seconds (mean = 2.66 +/- 1.28; P < .0001). Peak velocity of retrograde flow in competent valves was between 12 and 65 cm/s (mean = 26.2 +/- 11.1 cm/s) and between 25 and 160 cm/s (mean = 89.5 +/- 39.3 cm/s; P < .0001) in insufficient valves. On B-mode imaging, the "typical" aspect of an immobile, frozen valve was seen only in 5 cases of insufficient valves; 21 insufficient valves did not display this aspect.
  
  
  CONCLUSIONS
  The duration of retrograde flow clearly discriminates competent and incompetent valves. On the basis of our results, we provide cut off values that help differentiate between physiological and insufficiency reflux. The differences in peak velocity and morphology criteria are helpful but not reliable to predict insufficiency of the valve.
authors.affiliation: Department of Neurology, Johannes Gutenberg University, Mainz, Germany. nedelmann@neurologie.klinik.uni-mainz.de
authors.forename: Max
authors.initials: M
authors.lastname: Nedelmann
authors.forename: B Martin
authors.initials: BM
authors.lastname: Eicke
authors.forename: Marianne
authors.initials: M
authors.lastname: Dieterich
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D018616:Ultrasonography, Doppler, Duplex; D014636:Valsalva Maneuver; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology