An Ultrasonographic Technique to Assess the Jugular Venous Pulse: A Proof of Concept

Sisini, Francesco; Tessari, Mirko; Gadda, Giacomo; Domenico, Giovanni Di; Taibi, Angelo; Menegatti, Erica; Gambaccini, M.; Zamboni, Paolo

doi:10.1016/j.ultrasmedbio.2014.12.666

Cited by 40 publications

(44 citation statements)

References 34 publications

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“…For each subject, the CSA dataset, representing the instantaneous value of the CSA during a cardiac cycle, was derived from the acquired video clip using the semiautomatic algorithm described in [ 4 ]. The period T of the IJV pulsation was obtained by its discrete Fourier transform calculated using the Grace software [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…In a recent paper [ 4 ] we proved that JVP can be obtained by a simple ultrasound (US) B-mode investigation that consists in measuring the cross-sectional area (CSA) of the IJV on each sonogram of video clip acquired in the transversal plane. In that paper, we acquired the time-dependent CSA datasets of three healthy subjects and then calculated the autocorrelation function of the datasets to show that they were periodic and finally we showed that their wave form presented the same a , c , and v waves as the JVP.…”

Section: Introductionmentioning

confidence: 99%

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The Oscillating Component of the Internal Jugular Vein Flow: The Overlooked Element of Cerebral Circulation

Sisini

Toro

Gambaccini

et al. 2015

Behavioural Neurology

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The jugular venous pulse (JVP) provides valuable information about cardiac haemodynamics and filling pressures and is an indirect estimate of the central venous pressure (CVP). Recently it has been proven that JVP can be obtained by measuring the cross-sectional area (CSA) of the IJV on each sonogram of an ultrasound B-mode sonogram sequence. It has also been proven that during its pulsation the IJV is distended and hence that the pressure gradient drives the IJV haemodynamics. If this is true, then it will imply the following: (i) the blood velocity in the IJV is a periodic function of the time with period equal to the cardiac period and (ii) the instantaneous blood velocity is given by a time function that can be derived from a flow-dynamics theory that uses the instantaneous pressure gradient as a parameter. The aim of the present study is to confirm the hypothesis that JVP regulates the IJV blood flow and that pressure waves are transmitted from the heart toward the brain through the IJV wall.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Oscillating Component of the Internal Jugular Vein Flow: The Overlooked Element of Cerebral Circulation

Sisini

Toro

Gambaccini

et al. 2015

Behavioural Neurology

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“…The flattened flow rate waveform of cerebral sinus veins can be due to their fixed diameter and protective effect of the dura mater [ 31 ]. Moreover, the IJV cross sectional area changes over the cardiac cycle [ 62 ]. However, due to the high inter-subject variability in terms of IJV cross sectional areas and ranges of variation, the choice of considering an average constant value can be considered a reasonable approximation.…”

Section: Discussionmentioning

confidence: 99%

An anatomy-based lumped parameter model of cerebrospinal venous circulation: can an extracranial anatomical change impact intracranial hemodynamics?

et al. 2015

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BackgroundThe relationship between extracranial venous system abnormalities and central nervous system disorders has been recently theorized. In this paper we delve into this hypothesis by modeling the venous drainage in brain and spinal column areas and simulating the intracranial flow changes due to extracranial morphological stenoses.MethodsA lumped parameter model of the cerebro-spinal venous drainage was created based on anatomical knowledge and vessels diameters and lengths taken from literature. Each vein was modeled as a hydraulic resistance, calculated through Poiseuille’s law. The inputs of the model were arterial flow rates of the intracranial, vertebral and lumbar districts. The effects of the obstruction of the main venous outflows were simulated. A database comprising 112 Multiple Sclerosis patients (Male/Female = 42/70; median age ± standard deviation = 43.7 ± 10.5 years) was retrospectively analyzed.ResultsThe flow rate of the main veins estimated with the model was similar to the measures of 21 healthy controls (Male/Female = 10/11; mean age ± standard deviation = 31 ± 11 years), obtained with a 1.5 T Magnetic Resonance scanner. The intracranial reflux topography predicted with the model in cases of internal jugular vein diameter reduction was similar to those observed in the patients with internal jugular vein obstacles.ConclusionsThe proposed model can predict physiological and pathological behaviors with good fidelity. Despite the simplifications introduced in cerebrospinal venous circulation modeling, the key anatomical feature of the lumped parameter model allowed for a detailed analysis of the consequences of extracranial venous impairments on intracranial pressure and hemodynamics.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0352-y) contains supplementary material, which is available to authorized users.

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“…The IJV is not only pulsatile, but one more important mechanical property of such vein is the distensibility. The latter was proven by the strong correlation between CSA and perimeter variation ( r = 0.98) [ 41 ]. When the IJV is distended, the transmural pressure (i.e., the difference between the internal venous pressure and the atmospheric external pressure) and the CSA are correlated [ 42 ]; therefore, the time diagram of the IJV CSA reflects the JVP.…”

Section: The Ultrasound Evaluation Of Jvp (Us Jvp)mentioning

confidence: 99%

Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse

Zamboni

2016

Behavioural Neurology

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Assessment of cerebral venous return is growing interest for potential application in clinical practice. Doppler ultrasound (DUS) was used as a screening tool. However, three meta-analyses of qualitative DUS protocol demonstrate a big heterogeneity among studies. In an attempt to improve accuracy, several authors alternatively measured the flow rate, based on the product of the time average velocity with the cross-sectional area (CSA). However, also the quantification protocols lacked of the necessary accuracy. The reasons are as follows: (a) automatic measurement of the CSA assimilates the jugular to a circle, while it is elliptical; (b) the use of just a single CSA value in a pulsatile vessel is inaccurate; (c) time average velocity assessment can be applied only in laminar flow. Finally, the tutorial describes alternative ultrasound calculation of flow based on the Womersley method, which takes into account the variation of the jugular CSA overtime. In the near future, it will be possible to synchronize the electrocardiogram with the brain inflow (carotid distension wave) and with the outflow (jugular venous pulse) in order to nicely have a noninvasive ultrasound picture of the brain-heart axis. US jugular venous pulse may have potential use in neurovascular, neurocognitive, neurosensorial, and neurodegenerative disorders.

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An Ultrasonographic Technique to Assess the Jugular Venous Pulse: A Proof of Concept

Cited by 40 publications

References 34 publications

The Oscillating Component of the Internal Jugular Vein Flow: The Overlooked Element of Cerebral Circulation

The Oscillating Component of the Internal Jugular Vein Flow: The Overlooked Element of Cerebral Circulation

An anatomy-based lumped parameter model of cerebrospinal venous circulation: can an extracranial anatomical change impact intracranial hemodynamics?

Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse

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