網誌文章搜尋建議

給多發性硬化症MS病友和親友的建議:
如要搜尋站內相關文章可多利用
"搜尋此網誌的文章內容"的功能,這樣就可以快速的找到你想要得資訊而不需要從第一篇開始看了.
有關CCSVI(靜脈血管窄化及手術的資訊)可在相關連結以及相關MS blog內

推薦頻道:Gimmy a break

2013年7月27日 星期六

桑伯尼醫師 2013年 針對CCSVI 新研究論文發表

An ultrasound model to calculate the brain blood outflow through collateral vessels: a pilot study

Paolo Zamboni1*Francesco Sisini2Erica Menegatti1Angelo Taibi2Anna M Malagoni1Sandra Morovic3 and Mauro Gambaccini2


1Vascular Diseases Center, University of Ferrara, Via Aldo Moro 8, 44124, Cona, (FE), Italy
2Department of Physics, University of Ferrara, Via Saragat 1, 44122 Ferrara, Italy
3Aviva Medical Centre, Nemetova 2 10 000, Zagreb, Croatia
For all author emails, please log on.


BMC Neurology 2013, 13:81 doi:10.1186/1471-2377-13-81

The electronic version of this article is the complete one and can be found online at:http://www.biomedcentral.com/1471-2377/13/81

Received:30 April 2013
Accepted:5 July 2013
Published:11 July 2013
© 2013 Zamboni et al.; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Conclusion

We developed a new model that permits a detailed ECD quantification of the cerebral venous return, including an estimation of the amount of blood flowing from the collaterals to the caval system or to the IJV. The preliminary application of the model seems to indicate how a significant rate of the head inflow is drained by the collateral network rather than by the IJV in the CCSVI condition. This may help the interpretation of several findings assessed with different techniques, where it was not possible to assess the outflow contribution of the collateral network, as well as the rate of the inflow going in the main venous paths. For instance, the higher flow in the collateral network may explain the longer cerebral circulation time measured by means of contrast-enhanced US, as well as the slower discharge and increased resistance measured in MS [32-34]. Our preliminary report needs to be further corroborated by reproducibility analysis, wider number of subjects and pathological conditions, and possibly, by a multicenter design. This may lead to a further advancement for the circulatory quantification of the CCSVI condition in the clinical setting via ultrasonography.

Endnote

aThe named indexes are subject to copyright.

Abbreviations

Brain-C: Brain compartment; CBF: cerebral blood flow; CCA: Common carotid artery; CFI: Collateral Flow Index; CSA: Cross sectional area; CCDI: Cerebral Collateral Draining Index; CCSVI: Chronic Cerebrospinal venous insufficiency; CVO: Cerebral venous outflow; DCVO: Delta Cerebral Venous Outflow; DJVDI: Distal, Jugular Vertebral Draining Index; ECA: External carotid artery; ECD: Echo coulor Doppler; HBinF: Head blood in-flow; HBoutF: Head blood out-flow; HC: Healthy control; ICA: Internal carotid; IJVs: Internal jugular veins; PT: Total of patients; FN-C: Facial and neck compartment; SV: Sample volume; TAV: Time average velocity; VA: Vertebral artery; VVs: Vertebral veins.


References

  1. Gisolf J, van Lieshout JJ, van Heusden K, Pott F, Stok WJ, Karemaker JM: Human cerebral venous outflow pathway depends on posture and central venous pressure.
    J Physiol 2004, 560:317-327. PubMed Abstract | Publisher Full Text |PubMed Central Full Text OpenURL
  2. Schaller B: Physiology of cerebral venous blood flow: from experimental data in animals to normal function in humans.
    Brain Res Rev 2004, 46:243-260. PubMed Abstract | Publisher Full Text OpenURL
  3. Valdueza JM, von Münster T, Hoffman O, Schreiber S, Einhäupl KM: Postural dependency of the cerebral venous outflow.
    Lancet 2000, 355:200-201. PubMed Abstract | Publisher Full Text OpenURL
  4. Doepp F, Schreiber SJ, von Münster T, Rademacher J, Klingebiel R, Valdueza JM:How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns.
    Neuroradiology 2004, 46:565-570. PubMed Abstract | Publisher Full Text OpenURL
  5. Zamboni P, Morovic S, Menegatti E, Viselner G, Nicolaides AN, The Intersociety Faculty: Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound. Recommendation for a protocol.
    Int Angiol 2011, 30:571-597. PubMed Abstract | Publisher Full Text OpenURL
  6. Zamboni P, Menegatti E, Pomidori L, Morovic S, Taibi A, Malagoni AM, Cogo AL, Gambaccini M: Does thoracic pump influence the cerebral venous return?
    J Appl Physiol 2012, 112:904-910. PubMed Abstract | Publisher Full Text OpenURL
  7. Zamboni P, Consorti G, Galeotti R, Gianesini S, Menegatti E, Tacconi G, Carinci F:Venous collateral circulation of the extracranial cerebrospinal outflow routes.
    Curr Neurovasc Res 2009, 6:204-212. PubMed Abstract | Publisher Full Text OpenURL
  8. Evans DH: On the measurement of the mean velocity of blood flow over the cardiac cycle using Doppler ultrasound.
    Ultrasound Med Biol 1985, 11:735-741. PubMed Abstract | Publisher Full Text OpenURL
  9. Maulik D: Doppler ultrasound in obstetrics and gynaecology. Heidelberg: Springer; 1996. OpenURL
  10. Hoskins P, Thrush A, Martin K, Whittingam T: Diagnostic Ultrasound: Physics and Equipment Diagnostic, Greenwich Medical Media. New York, NY: Cambridge University Press; 2010. OpenURL
  11. Ponzini R, Vergara C, Rizzo G, Veneziani A, Roghi A, Vanzulli A, Parodi O, Redaelli A:Womersley number-based estimates of blood flow rate in Doppler analysis: in vivo validation by means of phase-contrast MRI.
    IEEE Trans Biomed Eng 2010, 57:1807-1815. PubMed Abstract | Publisher Full Text OpenURL
  12. Li S, Hoskins PR, Anderson T, McDicken WN: Measurement of mean velocity during pulsatile flow using time-averaged maximum frequency of Doppler ultrasound waveforms.
    Ultrasound Med Biol 1993, 19:105-113. PubMed Abstract | Publisher Full Text OpenURL
  13. Zhong Z, Song H, Chui TY, Petrig BL, Burns SA: Noninvasive measurements and analysis of blood velocity profiles in human retinal vessels.
    Invest Ophthalmol Vis Sci 2011, 52:4151-4157. PubMed Abstract |Publisher Full Text | PubMed Central Full Text OpenURL
  14. Vergara C, Ponzini R, Veneziani A, Redaelli A, Neglia D, Parodi O: Womersley number-based estimation of flow rate with Doppler ultrasound: sensitivity analysis and first clinical application.
    Comput Methods Programs Biomed 2010, 98(2):151-160.
    May
    PubMed Abstract | Publisher Full Text OpenURL
  15. Womersley JR: Flow in the larger arteries and its relation to the oscillating pressure.
    J Physiol 1954, 124(2):31-32. PubMed Abstract OpenURL
  16. Yamamoto M, Carrillo J, Insunza A, Mari G, Ville Y: Error Introduced into Velocity Measurements by Inappropriate Doppler Angle Assignment.
    Ultrasound Obstet Gynecol 2006, 28(6):853-854. PubMed Abstract |Publisher Full Text OpenURL
  17. Schoning M, Walter J, Scheel P: Estimation of Cerebral Blood Flow Through Color Duplex Sonography of the Carotid and Vertebral Arteries in Healthy Adults.
    Stroke 2004, 25:17-22. OpenURL
  18. Mortensen JD, Talbot S, Burkart JA: Cross sectional Internal Diameters of Human Cervical and Femoral Blood Vessels: Relationship to Subject’s Sex, Age, Body Size.
    Anat Rec 1990, 226(1):115-124. PubMed Abstract | Publisher Full Text OpenURL
  19. Doepp F, Paul F, Valdueza JM, Schmierer K, Schreiber SJ: No cerebrocervical venous congestion in patients with multiple sclerosis.
    Ann Neurol 2010, 68:173-183. PubMed Abstract | Publisher Full Text OpenURL
  20. Bastianello S, Bergamaschi F, Viselner G, et al.: An international multicenter observatory on prevalence of CCSVI in MS.
    BMC Neurol 2011.
    in press
    OpenURL
  21. Monti L, Menci E, Ulivelli M, Cerase A, Bartalini S, Piu P, Marotti N, Leonini S, Galluzzi P, Romano DG, Casasco AE, Venturi C: Quantitative ColourDopplerSonography evaluation of cerebral venous outflow: a comparative study between patients with multiple sclerosis and controls.
    PLoSOne 2011, 6(9):e25012. OpenURL
  22. Mayer CA, Waltraud P, Matthias WL, Nedelmann M, Bechmann I, Ziemann , Steinmetz : The perfect crime? CCSVI not leaving a trace in MS.
    J Neurol Neurosurg Psychiatry 2011, 82:436-440. PubMed Abstract |Publisher Full Text | PubMed Central Full Text OpenURL
  23. Baracchini C, Perini P, Calabrese M, Causin F, Rinaldi F, Gallo P: No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset.
    Ann Neurol 2011, 69:90-99. PubMed Abstract | Publisher Full Text OpenURL
  24. Blinkenberg M, Akeson P, Sillesen H, Lövgaard S, Sellebjerg F, Paulson OB, Siebner HR, Sørensen PS: Chronic cerebrospinal venous insufficiency and venous stenoses in multiple sclerosis.
    Acta Neurol Scand 2012, 126(6):421-427. PubMed Abstract | Publisher Full Text OpenURL
  25. McAuliffe W, Kermode AG: Mystery of Chronic Cerebrospinal Venous Insufficiency: Identical Venographic and Ultrasound Findings in Patients with MS and Controls.
    AJNR Am J Neuroradiol 2013.
    Jan 31. [Epub ahead of print]
    OpenURL
  26. Utriainen D, Trifan G, Sethi S, Elias S, Hewett J, Feng W, Haacke EM: Magnetic resonance imaging signatures of vascular pathology in multiple sclerosis.
    Neurol Res 2012, 34(8):780-92.
    Oct
    PubMed Abstract | Publisher Full Text OpenURL
  27. Utriainen D, Feng W, Elias S, Latif Z, Hubbard D, Haacke EM: Using magnetic resonance imaging as a means to study chronic cerebral spinal venous insufficiency in multiple sclerosis patients.
    Tech Vasc Interv Radiol 2012, 15(2):101-12.
    Jun
    PubMed Abstract | Publisher Full Text OpenURL
  28. Laupacis A, Lillie E, Dueck A, Straus S, Perrier L, Burton JM, Aviv R, Thorpe K, Feasby T, Spears J: Association between chronic cerebrospinal venous insufficiency and multiple sclerosis: a meta-analysis.
    CMAJ 2011, 183(16):E1203-12. PubMed Abstract | Publisher Full Text |PubMed Central Full Text OpenURL
  29. Zivadinov R, Schirda C, Dwyer MG, Haacke ME, Weinstock-Guttman B, Menegatti E, Heininen-Brown M, Magnano C, Malagoni AM, Wack DS, Hojnacki D, Kennedy C, Carl E, Bergsland N, Hussein S, Poloni G, Bartolomei I, Salvi F, Zamboni P: Chronic cerebrospinal venous insufficiency and iron deposition on susceptibility-weighted imaging in patients with multiple sclerosis: a pilot case-control study.
    Int Angiol 2010, 29(2):158-75. PubMed Abstract | Publisher Full Text OpenURL
  30. Pozniak MA, Zagzebski JA, Scanlan KA: Spectral Doppler and Color Doppler Artifacts.
    Radiographics 1992, 12:35-44. PubMed Abstract | Publisher Full Text OpenURL
  31. Steinman AH, Yu AC, Johnston KW, Cobbold RS: Effects of beam steering in pulsed-wave ultrasound velocity estimation.
    Ultrasound Med Biol 2005, 31(8):1073-1082. PubMed Abstract | Publisher Full Text OpenURL
  32. Mancini M, Morra VB, Di Donato O, et al.: Multiple sclerosis: cerebral circulation time.
    Radiol 2012, 262(3):947-955. Publisher Full Text OpenURL
  33. Beggs C, Shepherd S, Zamboni P: Cerebral venous outflow resistance and interpretation of cervical plethysmography data with respect to the diagnosis of chronic cerebrospinal venous insufficiency.
    Phlebology 2012.
    Oct 11. [Epub ahead of print]
    OpenURL
  34. Zamboni P, Menegatti E, Conforti P, Shepherd S, Tessari M, Beggs C: Assessment of cerebral venous return by a novel plethysmography method.
    J Vasc Surg 2012, 56(3):677-685. PubMed Abstract | Publisher Full Text OpenURL

Pre-publication history

The pre-publication history for this paper can be accessed here:

Share/Bookmark

沒有留言:

張貼留言

留言