Assessment of cerebral venous return by a novel plethysmography method

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Assessment of cerebral venous return by a novel plethysmography method Paolo Zamboni, MD, Erica Menegatti, PhD, Paolo Conforti, MD, Simon Shepherd, PhD, Mirko Tessari, VT, Clive Beggs, PhD Journal of Vascular Surgery Volume 56, Issue 3, Pages 677-685.e1 (September 2012) DOI: 10.1016/j.jvs.2012.01.074 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 B-mode evaluation of internal jugular veins in longitudinal plane showing: (A) tiny and hyperechoic intraluminal obstacle (septum), and (B) wall stenosis leading to well-apparent reduction of the jugular lumen. Journal of Vascular Surgery 2012 56, 677-685.e1DOI: (10.1016/j.jvs.2012.01.074) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 The operator places the strain gauge around the neck of the subject and rapidly tilts the chair backward from 90° to 0° (<1.8 seconds). When the blood volume curve reaches a plateau, the subject is again tilted forward to the upright position (<1.8 seconds). Journal of Vascular Surgery 2012 56, 677-685.e1DOI: (10.1016/j.jvs.2012.01.074) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 The plethysmographic trace is represented by the solid line, with the gravitational gradient (measured by the sensor positioned on the tilt chair) represented by the dotted line. For each experimental run, the following key parameters were recorded: the venous volume (VV); the filling time (FT) required to achieve 90% of VV (90% VV); the residual volume (RV); and the emptying time (ET) required to achieve 90% of emptying volume (90% EV), where EV = VV − RV. Journal of Vascular Surgery 2012 56, 677-685.e1DOI: (10.1016/j.jvs.2012.01.074) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Representative plethysmography plots for a healthy individual and a patient with chronic cerebrospinal venous insufficiency (CCSVI). Journal of Vascular Surgery 2012 56, 677-685.e1DOI: (10.1016/j.jvs.2012.01.074) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 5 A considerable overlap area between controls (cross) and patients with chronic cerebrospinal venous insufficiency (CCSVI; circles) is clearly visible by plotting the filling gradient (FG) with emptying gradient (EG) values, respectively. Journal of Vascular Surgery 2012 56, 677-685.e1DOI: (10.1016/j.jvs.2012.01.074) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 6 The result of principal component (PC) analysis. Left panel, comparison of the correlation between the first PC and emptying gradient (EG) found in controls (cross; R2 = 1.000) vs chronic cerebrospinal venous insufficiency (CCSVI; circles) (R2 = 0.781). Right panel, comparison plotting the second PC against filling gradient (FG), again stronger in controls (cross; R2 = 1.000) than in CCSVI (circles; R2 = 0.515). Journal of Vascular Surgery 2012 56, 677-685.e1DOI: (10.1016/j.jvs.2012.01.074) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 7 Plot of the first and second principal components (PCs) for chronic cerebrospinal venous insufficiency (CCSVI) and healthy controls (HCs). Journal of Vascular Surgery 2012 56, 677-685.e1DOI: (10.1016/j.jvs.2012.01.074) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 8 Receiver operating characteristic (ROC) analysis comparing one variable model (emptying time [ET], dashed line) with three-variables model (ET, filling gradient [FG], and emptying volume [EV], interrupted line). The area under the curve in the latter (ROC area, 0.8386) seems not to significantly increase the diagnostic accuracy (ROC area, 0.7815). Journal of Vascular Surgery 2012 56, 677-685.e1DOI: (10.1016/j.jvs.2012.01.074) Copyright © 2012 Society for Vascular Surgery Terms and Conditions