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Catheter-directed venography for evaluating internal jugular vein pseudo-occlusion
Ryan W England1, Anirudh Arun1, Peter S Vosler2
1The Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Summary
Computed tomography venography (CTV) may suggest internal jugular vein (IJV) occlusion, but invasive digital subtraction venography (DSV) often reveals venous patency. DSV is crucial for accurately assessing IJV stenosis and flow.
Area of Science:
- Vascular imaging
- Neurology
- Interventional radiology
Background:
- Cerebral venous system stenosis, particularly internal jugular vein (IJV) occlusion, has poorly understood incidence and effects.
- Noninvasive imaging like computed tomography venography (CTV) may inaccurately suggest complete IJV occlusion when the vein is patent.
Purpose of the Study:
- To compare the diagnostic accuracy of CTV versus digital subtraction venography (DSV) in evaluating internal jugular vein (IJV) patency or occlusion.
- To assess the utility of invasive catheter-directed venography in characterizing suspected IJV stenosis.
Main Methods:
- Retrospective analysis of patients with suspected IJV occlusion on CTV.
- Comparison of CTV findings with invasive DSV, including assessment of flow direction, vessel caliber, and manometry.
- Inclusion of patients with imaging of both the suspected occluded IJV and the contralateral IJV.
Main Results:
- Digital subtraction venography (DSV) demonstrated patency in all four internal jugular veins (IJVs) initially suspected of occlusion by CTV.
- CTV findings for contralateral IJVs showed concordance with DSV regarding patency and stenosis severity.
- Mean pressure gradients across suspected occlusions were minimal, suggesting non-obstructive findings.
Conclusions:
- Computed tomography venography (CTV) may be insufficient for definitively diagnosing complete internal jugular vein (IJV) occlusion.
- Catheter-directed venography, including DSV, is essential for accurate assessment of IJV patency, caliber, and pressure gradients in cases of suspected stenosis.
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