Evaluation of the transverse venous sinus with transcranial color-coded duplex

Ultrasound-derived diagnosis of transverse venous sinus stenosis (TVSS) may have a promise given recent exploration of its role in pathophysiology of intracranial hypertension and availability of interventions like venous stenting. We investigated transverse venous sinus (TVS) insonation using transcranial color-coded duplex (TCCD) to establish normative values, inform on inherent physiological variability, and other measures to allow future studies on testing the construct validity of TCCD venous in diagnosing TVSS.

An institutional review board-approved prospective observational study evaluated 20 healthy volunteers to define TCCD-based measures for the TVS. Comparatively, the basal vein of Rosenthal, deep middle cerebral veins, and internal jugular veins were insonated. We report on physiological variability including the intrasubject, intersubject, and side-to-side variability; gradient of TVS velocities on each side from medial to lateral insonation; and the relationship between TVS and other insonated venous structures.

Fifteen out of 20 subjects had the TVS insonated bilaterally, and five had unilaterally (four right, one left). TVS velocities had comparable intrasubject variability to other intracranial veins insonated and lower velocity-based variability than the pulsatility index. There was significant side-side variability in TVS-derived measures without discernible patterns. Insonating TVS from medial to lateral revealed a gradient with a bimodal peak in ultrasound-derived velocities. We did not find discernible relationships between TVS and other veins for TCCD-derived measures.

These results can inform future studies validating the normative values in a larger sample and help explore the role of TCCD venous in the diagnosis of venous sinus stenosis.