title: MR Elastography Can Be Used to Measure Brain Stiffness Changes as a Result of Altered Cranial Venous Drainage During Jugular Compression.
abstract: OBJECTIVE
  Compressing the internal jugular veins can reverse ventriculomegaly in the syndrome of inappropriately low pressure acute hydrocephalus, and it has been suggested that this works by "stiffening" the brain tissue. Jugular compression may also alter blood and CSF flow in other conditions. We aimed to understand the effect of jugular compression on brain tissue stiffness and CSF flow.
  
  
  METHODS
  The head and neck of 9 healthy volunteers were studied with and without jugular compression. Brain stiffness (shear modulus) was measured by using MR elastography. Phase-contrast MR imaging was used to measure CSF flow in the cerebral aqueduct and blood flow in the neck.
  
  
  RESULTS
  The shear moduli of the brain tissue increased with the percentage of blood draining through the internal jugular veins during venous compression. Peak velocity of caudally directed CSF in the aqueduct increased significantly with jugular compression (P < .001). The mean jugular venous flow rate, amplitude, and vessel area were significantly reduced with jugular compression, while cranial arterial flow parameters were unaffected.
  
  
  CONCLUSIONS
  Jugular compression influences cerebral CSF hydrodynamics in healthy subjects and can increase brain tissue stiffness, but the magnitude of the stiffening depends on the percentage of cranial blood draining through the internal jugular veins during compression—that is, subjects who maintain venous drainage through the internal jugular veins during jugular compression have stiffer brains than those who divert venous blood through alternative pathways. These methods may be useful for studying this phenomenon in patients with the syndrome of inappropriately low-pressure acute hydrocephalus and other conditions.
authors.affiliation: From Neuroscience Research Australia (A.H., S.C., K.T., L.E.B.), Randwick, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Hatt
authors.affiliation: From Neuroscience Research Australia (A.H., S.C., K.T., L.E.B.), Randwick, New South Wales, Australia School of Mechanical Engineering (S.C.), Macquarie University, North Ryde, New South Wales, Australia School of Medical Sciences (S.C.).
authors.forename: S
authors.initials: S
authors.lastname: Cheng
authors.affiliation: From Neuroscience Research Australia (A.H., S.C., K.T., L.E.B.), Randwick, New South Wales, Australia Graduate School of Biomedical Engineering (K.T.), University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: K
authors.identifier: http://orcid.org/0000-0003-0976-3808
authors.initials: K
authors.lastname: Tan
authors.affiliation: British Heart Foundation Centre of Excellence (R.S.), Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Sinkus
authors.affiliation: From Neuroscience Research Australia (A.H., S.C., K.T., L.E.B.), Randwick, New South Wales, Australia Prince of Wales Clinical School (L.E.B.), University of New South Wales, Randwick, New South Wales, Australia. l.bilston@neura.edu.au.
authors.forename: L E
authors.initials: LE
authors.lastname: Bilston
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology*; D002555:Cerebrospinal Fluid / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003251:Constriction, Pathologic / Q000503:physiopathology; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000503:physiopathology; D007601:Jugular Veins / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D033081:Shear Strength / Q000502:physiology