title: Reproducibility of cerebrospinal venous blood flow and vessel anatomy with the use of phase contrast-vastly undersampled isotropic projection reconstruction and contrast-enhanced MRA.
abstract: OBJECTIVE
  The chronic cerebrospinal venous insufficiency hypothesis raises interest in cerebrospinal venous blood flow imaging, which is more complex and less established than in arteries. For accurate assessment of venous flow in chronic cerebrospinal venous insufficiency diagnosis and research, we must account for physiologic changes in flow patterns. This study examines day-to-day flow variability in cerebrospinal veins by use of 4D MR flow and contrast-enhanced MRA under typical, uncontrolled conditions in healthy individuals.
  
  
  METHODS
  Ten healthy volunteers were scanned in a test-retest fashion by use of a 4D flow MR imaging technique and contrast-enhanced MRA. Flow parameters obtained from phase contrast-vastly undersampled isotropic projection reconstruction and contrast-enhanced MRA scoring measurements in the head, neck, and chest veins were analyzed for internal consistency and interscan reproducibility.
  
  
  RESULTS
  Internal consistency was satisfied at the torcular herophili, with an input-output difference of 2.2%. Percentages of variations in flow were 20.3%, internal jugular vein; 20.4%, azygos vein; 6.8%, transverse sinus; and 5.1%, common carotid artery. Retrograde flow was found in the lower internal jugular vein (4.8%) and azygos vein (7.2%). Contrast-enhanced MRA interscan κ values for the internal jugular vein (left: 0.474, right: 0.366) and azygos vein (-0.053) showed poor interscan agreement.
  
  
  CONCLUSIONS
  Phase contrast-vastly undersampled isotropic projection reconstruction blood flow measurements are reliable and highly reproducible in intracranial veins and in the common carotid artery but not in veins of the neck (internal jugular vein) and chest (azygos vein) because of normal physiologic variation. Retrograde flow normally may be observed in the lower internal jugular vein and azygos vein. Low interrater agreement in contrast-enhanced MRA scans was observed. These findings have important implications for imaging diagnosis and experimental research of chronic cerebrospinal venous insufficiency.
authors.affiliation: From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.) schrau24@gmail.com.
authors.forename: E M
authors.initials: EM
authors.lastname: Schrauben
authors.affiliation: From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.).
authors.forename: K M
authors.initials: KM
authors.lastname: Johnson
authors.affiliation: Radiology (J.H., S.B.R., A.F., O.W.), University of Wisconsin, Madison, Wisconsin.
authors.forename: J
authors.initials: J
authors.lastname: Huston
authors.affiliation: From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.).
authors.forename: A M
authors.initials: AM
authors.lastname: Del Rio
authors.affiliation: From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.)Radiology (J.H., S.B.R., A.F., O.W.), University of Wisconsin, Madison, Wisconsin.
authors.forename: S B
authors.initials: SB
authors.lastname: Reeder
authors.affiliation: Radiology (J.H., S.B.R., A.F., O.W.), University of Wisconsin, Madison, Wisconsin.
authors.forename: A
authors.initials: A
authors.lastname: Field
authors.affiliation: From the Departments of Medical Physics (E.M.S., K.M.J., A.M.d.R., S.B.R., O.W.)Radiology (J.H., S.B.R., A.F., O.W.), University of Wisconsin, Madison, Wisconsin.
authors.forename: O
authors.initials: O
authors.lastname: Wieben
mesh_terms: D000328:Adult; D000465:Algorithms; D016880:Anisotropy; D001783:Blood Flow Velocity / Q000502:physiology; D002550:Cerebral Veins / Q000033:anatomy & histology* / Q000502:physiology*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D018401:Sample Size; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000098:blood supply*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium