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Comparison of Intravascular Ultrasound with Conventional Venography for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal.

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Presentation on theme: "Comparison of Intravascular Ultrasound with Conventional Venography for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal."— Presentation transcript:

1 Comparison of Intravascular Ultrasound with Conventional Venography for Detection of Extracranial Venous Abnormalities Indicative of Chronic Cerebrospinal Venous Insufficiency  Yuval Karmon, MD, Robert Zivadinov, MD, PhD, Bianca Weinstock-Guttman, MD, Karen Marr, RVT, RDMS, Vesela Valnarov, MD, RVT, ARDMS, RPVI, Kresimir Dolic, MD, Cheryl L. Kennedy, LMSW, MPH, David Hojnacki, MD, Ellen M. Carl, MA, Jesper Hagemeier, MS, L. Nelson Hopkins, MD, Elad I. Levy, MD, Adnan H. Siddiqui, MD, PhD  Journal of Vascular and Interventional Radiology  Volume 24, Issue 10, Pages e1 (October 2013) DOI: /j.jvir Copyright © 2013 SIR Terms and Conditions

2 Figure 1 Examples of degree of stenosis (arrows in a, b, and c) demonstrated on conventional venography. (a) Nonsignificant (< 50%) stenosis in left IJ vein. (b) Significant (≥ 50%) stenosis in left IJ vein. (c) Significant (≥ 50%) stenosis in left IJ vein. Collateral veins (arrowheads) are shown from left to right in (d) minimal opacification at the skull base through the condylar and mastoid emissary veins, (e) opacification of the posterior jugular and deep cervical collateral veins, and (f) opacification of the posterior jugular, deep cervical, vertebral, and epidural venous plexuses. Journal of Vascular and Interventional Radiology  , e1DOI: ( /j.jvir ) Copyright © 2013 SIR Terms and Conditions

3 Figure 2 (a) Example of azygos vein stenosis showing hazy contrast opacification in the region of the stenosis on conventional angiography (white arrow) with multiple collaterals, including intersegmental and intercostal veins (black arrows), paravertebral venous plexus (blue arrow), and widespread epidural collaterals (small red arrows). The epidural plexus is best identified by its triangular appearance, with the apex directed laterally, which corresponds to the nerve root sleeve at each segment and on each side along which it exits the spinal canal. (b) IVUS axial image with sagittal reconstruction (star) demonstrating the venous wall (heterogeneous signal surrounding central black circle) circumferentially in contact with the IVUS probe (central black circle) and no evidence of vessel lumen consistent with azygos vein stenosis. (c) Significant stenosis of azygos vein (black arrow) on conventional venography with multiple collaterals, including epidural plexus (small red arrows); posterior thoracic, intersegmental, and hemiazygos collaterals (yellow arrow); and junction demonstrating epidural plexus draining into intersegmental-intercostal-paravertebral vessels (long red arrow). Journal of Vascular and Interventional Radiology  , e1DOI: ( /j.jvir ) Copyright © 2013 SIR Terms and Conditions

4 Figure 3 Serial phase recording of left IJ vein on conventional venography after contrast injection showing ET. Upper row: A 53-year-old woman with relapsing-remitting MS with an ET of 9.6 seconds (″) (photos cover 8 s with cuts at 0″, 2″, 4″, 6″, and 8″). Middle row: A 51-year-old man with relapsing-remitting MS and an ET of 9 seconds. Lower row: A 21-year-old woman with relapsing-remitting MS and an ET of 2.6 seconds. Journal of Vascular and Interventional Radiology  , e1DOI: ( /j.jvir ) Copyright © 2013 SIR Terms and Conditions

5 Figure 4 Examples of intraluminal abnormalities detected on IVUS. (a) Intraluminal hyperechoic filling defect (asterisk) with a typical crescentic shape, likely thin covering of endothelium (white arrow), second parallel channel with flowing blood (lumen) within hyperechoic filling defect (yellow arrow) within the true wall (red arrow), and true lumen (blue arrow) of the vein. (b) Double (parallel) lumen separated by a septa (white arrow) arising from a crescentic hyperechoic filling defect (yellow star) within in a large vein (wall demarcated by red arrows). (c) Axial images of IVUS reflecting critical stenosis with heterogeneous signal filling the vein hugging the IVUS probe (central black circle) and multiple small channels (black and white arrows) surrounding the stenosis. (d) Blood (darker upper half indicated by yellow arrow) and contrast material likely mixed with static blood (hyperechoic filling defect indicated by lower red arrow) level in the left IJ vein of a 46-year-old woman with relapsing-remitting MS (5 min after contrast injection ended) as a result of stagnation of contrast material and blood in the left IJ vein secondary to critical outflow stenosis. Journal of Vascular and Interventional Radiology  , e1DOI: ( /j.jvir ) Copyright © 2013 SIR Terms and Conditions


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