Estimation of venous sinus pressure drop in patients with idiopathic intracranial hypertension using 4D-flow MRI

Yupeng Zhang; Chao Ma; Shikai Liang; Changxuan Li; Haoyu Zhu; Zhiye Li; Zhongrong Miao; Xu Tong; Kehui Dong; Chuhan Jiang; Binbin Sui; Dapeng Mo

doi:10.1007/s00330-022-09199-z

Estimation of venous sinus pressure drop in patients with idiopathic intracranial hypertension using 4D-flow MRI

Eur Radiol. 2023 Apr;33(4):2576-2584. doi: 10.1007/s00330-022-09199-z. Epub 2022 Oct 26.

Authors

Yupeng Zhang^{1

2}, Chao Ma^{3

4}, Shikai Liang⁴, Changxuan Li⁵, Haoyu Zhu², Zhiye Li^{6

7}, Zhongrong Miao¹, Xu Tong¹, Kehui Dong¹, Chuhan Jiang², Binbin Sui⁶, Dapeng Mo⁸

Affiliations

¹ Interventional Neuroradiology Center, Beijing TianTan Hospital, Capital Medical University, Beijing, 100070, China.
² Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
³ School of Clinical Medicine, Tsinghua University, Beijing, China.
⁴ Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
⁵ Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Sanya, China.
⁶ Tiantan Neuroimaging Center for Excellence, China National Clinical Research Center for Neurological Diseases, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
⁷ Department of Radiology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
⁸ Interventional Neuroradiology Center, Beijing TianTan Hospital, Capital Medical University, Beijing, 100070, China. bjttmodp@163.com.

PMID: 36287270
DOI: 10.1007/s00330-022-09199-z

Abstract

Objective: We aimed to explore a non-invasive estimate of pressure drop in patients who undergo venous sinus stenting to treat idiopathic intracranial hypertension (IIH).

Methods: This prospective study included 28 IIH patients scheduled for venous stenting. 4D-flow MRI was acquired 24-48 h before venous manometry. Manometry-obtained pressure drop (Mp) was dichotomized into low (Lp: 0-8 mmHg) and high (Hp: 8-30 mmHg) groups. Hemodynamic indices were compared between Lp and Hp. Trans-stenotic pressure drop was estimated by work-energy equation, simplified Bernoulli equation, vorticity magnitude, and velocity difference between inlet and outlet and was compared with Mp. Measurement agreement, correlation, and accuracy were evaluated using the κ coefficient, Pearson's r, and confusion matrix-derived accuracy.

Results: Among 28 patients (mean age 38.8 ± 12.7), 19 (67.9%) were female. Work-energy equation-estimated pressure drop (WEp) had strong correlation (r = 0.91, 95% confidence interval [CI]: 0.81-0.96, p < 0.001) and high agreement (intraclass correlation coefficient = 0.90, 95% CI: 0.78-0.95, p < 0.001) with Mp. WEp classified Lp and Hp with an accuracy of 0.96. The κ value between WEp and Mp was 0.92 (95% CI: 0.78-1.00). In the work-energy equation, the viscosity energy term (V_e) had the largest weights, and the ratio of V_e to the summation of the three energy terms was 0.93 ± 0.07. V_e had strong correlation with mVort (r = 0.93, 95% CI: 0.85-0.97, p < 0.001), and mean vorticity magnitude was significantly elevated in Hp compared to that in Lp (259.8 vs. 174.9 mL/s, p < 0.001).

Conclusion: Trans-stenotic pressure drop in IIH can be estimated using the work-energy equation with favorable accuracy.

Key points: • Trans-stenotic pressure drop in patients with idiopathic intracranial hypertension can be estimated accurately with the work-energy equation using the 4D-flow MRI full velocity field. • Compared with traditional venous sinus manometry, the 4D-flow MRI-derived pressure drop is totally non-invasive and cost-saving. • 4D-flow MRI may help neurointerventionalist to select IIH patients suitable for venous sinus stenting.

Keywords: Cranial venous sinus; Idiopathic intracranial hypertension; MRI; Manometry.

MeSH terms

Adult
Constriction, Pathologic
Cranial Sinuses / diagnostic imaging
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Prospective Studies
Pseudotumor Cerebri* / complications
Pseudotumor Cerebri* / diagnostic imaging
Retrospective Studies
Stents