title: An ultrasound model to calculate the brain blood outflow through collateral vessels: a pilot study.
abstract: BACKGROUND
  The quantification of the flow returning from the head through the cervical veins and the collaterals of the internal jugular vein (IJV), is becoming of prominent interest in clinical practice. We developed a novel model to calculate the cerebral venous return, normalized to the arterial inflow, in the different segments of the IJV.
  
  
  METHODS
  We assessed, by established Echo Colour Doppler (ECD) methodology, the head inflow (HBinF) defined as the sum of common carotids and vertebral arteries, as well as the cerebral flow (CBF) defined as the sum of internal carotid and vertebral arteries. We also assessed the head outflow (HBoutF) defined as the sum of the measurements at the junction of the IJV and the vertebral veins. In addition, we also calculated the collateral flow index (CFI) by estimating the flow which re-enters directly into the superior vena cava as the amount of blood extrapolated by the difference between the HBinF and the HBoutF. We preliminarily tested the model by comparing ten healthy controls (HC) with ten patients affected by chronic cerebral spinal venous insufficiency (CCSVI), a condition characterized by some blockages in the IJV which are bypassed by collateral circulation.
  
  
  RESULTS
  In HC the HBinF was 956+-105ml/min, whereas the HBoutF was > 90% of the HBinF, leading to a final CFI value of 1%. The last result shows that a very small amount of blood is drained by the collaterals. In upright we confirmed a reduction of the outflow through the IJV which increased CFI to 9%. When we applied the model to CCSVI, the HBinF was not significantly different from controls. In supine, the flow of CCSVI patients in the IJV junction was significantly lower (p < 0.001) while the correspondent CFI value significantly increased (61%, p < 0.0002).
  
  
  CONCLUSIONS
  Our preliminary application of the novel model in the clinical setting suggests the pivotal role of the collateral network in draining the blood into the superior vena cava under CCSVI condition.
authors.affiliation: Vascular Diseases Center, University of Ferrara, Cona, (FE), Italy. paolozamboni@icloud.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Zamboni
authors.forename: Francesco
authors.initials: F
authors.lastname: Sisini
authors.forename: Erica
authors.initials: E
authors.lastname: Menegatti
authors.forename: Angelo
authors.initials: A
authors.lastname: Taibi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Malagoni
authors.forename: Sandra
authors.initials: S
authors.lastname: Morovic
authors.forename: Mauro
authors.initials: M
authors.lastname: Gambaccini
mesh_terms: D001921:Brain / Q000098:blood supply*; D002550:Cerebral Veins / Q000000981:diagnostic imaging*; D003097:Collateral Circulation / Q000502:physiology*; D006801:Humans; D008954:Models, Biological; D010865:Pilot Projects; D012039:Regional Blood Flow / Q000502:physiology*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*