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. 2022 Aug 8;12(8):612.
doi: 10.3390/bios12080612.

Cardiac and Respiratory Influences on Intracranial and Neck Venous Flow, Estimated Using Real-Time Phase-Contrast MRI

Maria Marcella Laganà  1 , Alice Pirastru  1   2 , Francesca Ferrari  2 , Sonia Di Tella  1   3 , Marta Cazzoli  1 , Laura Pelizzari  1 , Ning Jin  4 , Domenico Zacà  5 , Noam Alperin  6 , Giuseppe Baselli  2 , Francesca Baglio  1
Affiliations

Cardiac and Respiratory Influences on Intracranial and Neck Venous Flow, Estimated Using Real-Time Phase-Contrast MRI

Maria Marcella Laganà et al. Biosensors (Basel). .

Abstract

The study of brain venous drainage has gained attention due to its hypothesized link with various neurological conditions. Intracranial and neck venous flow rate may be estimated using cardiac-gated cine phase-contrast (PC)-MRI. Although previous studies showed that breathing influences the neck's venous flow, this aspect could not be studied using the conventional segmented PC-MRI since it reconstructs a single cardiac cycle. The advent of real-time PC-MRI has overcome these limitations. Using this technique, we measured the internal jugular veins and superior sagittal sinus flow rates in a group of 16 healthy subjects (12 females, median age of 23 years). Comparing forced-breathing and free-breathing, the average flow rate decreased and the respiratory modulation increased. The flow rate decrement may be due to a vasoreactive response to deep breathing. The respiratory modulation increment is due to the thoracic pump's greater effect during forced breathing compared to free breathing. These results showed that the breathing mode influences the average blood flow and its pulsations. Since effective drainage is fundamental for brain health, rehabilitative studies might use the current setup to investigate if respiratory exercises positively affect clinical variables and venous drainage.

Keywords: RT-PC MRI; intracranial venous flow; neck venous flow.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Steps for segmenting the internal jugular veins (IJVs) (a–c) and superior sagittal sinus (SSS) (d–f). Identification of a time point with high velocity (a,d); magnification of the vessels of interest (b,e); vessel surrounded by a segmentation box for initializing the region growing algorithm (c,f).
Figure 2
Figure 2
Internal jugular veins (IJV) and superior sagittal sinus (SSS) flow rate signals of an exemplificative subject. Different breathing scenarios, from left to right: free, paced normal, and paced deep breathing. The band pass filtered (BPF) flow-rate signal (dark blue), the respiratory signal (green), and the pulse signal (dark green) are also plotted.
Figure 3
Figure 3
Average flow rate boxplots for the internal jugular veins (IJVs, left panel) and the superior sagittal sinus (SSS, right panel). The associated FDR-corrected p-values are written over the box plots. Legend: F = free breathing; PN = paced normal breathing; PD = paced deep breathing.
Figure 4
Figure 4
Power spectrum densities (PSD) of one exemplificative subject’s IJVs and SSS flows. The PSD are separately reported for each breathing scenario (from left to right: free breathing, paced normal breathing and paced deep breathing).
Figure 5
Figure 5
Box plot of respiratory-to-cardiac power (Respiratory/Cardiac). Different breathing scenarios are compared, shown separately for internal jugular veins (IJVs) and the superior sagittal sinus (SSS). FDR-corrected p-values are reported over the box plots, highlighting significant differences. For each breathing mode, the between-vessel comparisons were never significant.
Figure 6
Figure 6
Box plot of the normalized area under the curve (NAUC) for the respiratory component. Different breathing scenarios are compared, shown separately for internal jugular veins (IJVs) and superior sagittal sinus (SSS). FDR-corrected p-values are reported for the significant paired comparisons. For each breathing mode, the between-vessel comparisons were never significant.
Figure 7
Figure 7
Boxplot of the normalized area under the curve (NAUC) for the cardiac component. Different breathing scenarios are compared, shown separately for internal jugular veins (IJVs) and superior sagittal sinus (SSS). FDR-corrected p-values are reported for the significant paired comparisons. For each breathing mode, the between-vessel comparisons were never significant.
Figure 8
Figure 8
Boxplots of the normalized AUC for the cardiac component vs. normalized AUC for the respiratory component. The comparisons were performed for each breathing scenario (free (F), paced normal (PN), and paced deep breathing (PD)), shown separately for internal jugular veins (IJVs, panel a) and the superior sagittal sinus (SSS, panel b).
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