Hemodynamic Assessments of Venous Pulsatile Tinnitus Using 4D-Flow MRI

[Frédéric]

Hemodynamic assessments of venous pulsatile tinnitus using 4D-flow MRI
Yunduo Li, Huijun Chen, Le He, Xiangyu Cao, Xianling Wang, Shubin Chen, Rui Li, Chun Yuan
First published July 11, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005948

Abstract
Objective To use 4D-flow MRI to characterize hemodynamics of transverse and sigmoid sinus in venous pulsatile tinnitus (PT) patients and to investigate their differences vs healthy controls.

Methods A total of 21 patients with venous PT and 11 healthy controls were included in the retrospective study. All participants underwent 4D-flow and magnetic resonance venography scan in a 3.0T magnetic resonance scanner. All visualization, quantification, and analysis of 4D-flow data were performed using dedicated software. Two independent reviewers evaluated the existence of vortex or turbulence. Covariance analysis adjusted for age was used to compare average through-plane velocity (Vtp_avg), maximum through-plane velocity (Vtp_max), average velocity (Vavg), maximum velocity (Vmax), average blood flow (Flowavg), and pulsatility index (PI) between PT and control group.

Results There were hemodynamic differences between PT patients and healthy controls. Compared with the control group, the PT group showed significantly higher Vtp_avg, Vtp_max, Vavg, Vmax, and Flowavg, and slightly higher PI. For the assessment of flow pattern, inter-reader reproducibility was excellent (κ = 1.00). Vortex or turbulence was observed in PT patients with good sensitivity (86.4%) and specificity (90.9%). Drainage dominance was more frequently observed in patients (15/21, 71.4%) than healthy controls (4/11, 36.4%).

Conclusions Significant hemodynamic differences were found between venous PT patients and healthy controls with 4D-flow MRI. Hemodynamic conditions could serve as noninvasive biomarkers for diagnosis and treatment evaluation of venous PT.

Classification of evidence This study provides Class III evidence that 4D-flow MRI accurately identifies patients with venous PT.

Source: http://n.neurology.org/content/early/2018/07/11/WNL.0000000000005948

 

[undecided]

Ok, they found that pulsatile tinnitus correlates with abnormal blood flow.
And I think people with PT know they have PT. Duh.
You don't need a 3 Tesla magnetic resonance scanner to get to that conclusion, any person in here could probably speculate that.
And no suggestion or thoughts about treatment? Maybe high blood pressure drugs, those ones that cause tinnitus in the first place?
I'm not trying to step on their findings and call out another useless research attempt.
This thing has been under research for 60 years and all we have is Jastreboff.

 

[Frédéric]

Similar research, although surgical intervention and results are not mentioned.

THE ROLE OF 4D-CTA IN THE IMAGING WORK UP OF PATIENTS WITH PULSATILE TINNITUS: A TECHNICAL NOTE

Background:
Pulsatile tinnitus (PT) is a debilitating condition that can be caused by various vascular conditions, including arteriovenous and venous lesions. Most of these lesions can be treated successfully by venous sinus stenting, however, the diagnosis of the venous cases remains a challenge.

The purpose of our study was to evaluate the effectiveness of 4DCTA for diagnosis of venous sinus lesions.

Methods:
Patients referred to our institution with symptoms of pulsatile tinnitus and inconclusive external imaging were included in our study between August 2019 to February 2020 (n=13). Patients underwent a 20s continuous volumetric 4D-CTA scan, with a 50cc bolus of iodinated contrast media injected intravenously. A 0.5s rotation time was used to produce forty 3D volumes demonstrating all phases from arterial to venous. Post-processing was performed to create 4D dynamic reconstructions of all phases. Two neuroradiologists examined the dynamic reconstructions of each patient to exclude arteriovenous disease and evaluate the venous phase.

Results:
A 4D-CTA was successfully performed in all 13 patients. Right sided pulsatile tinnitus was diagnosed in 85% of 4D-CTA scans (n=11/13; 15% left PT= 2/13). Ninety-two percent of cases had a stenosis on the side of PT (n=12/13), which was also the dominant venous drainage of the brain. All stenoses were ranked severe or sub-occlusive (3 or 4 points) on a 4 point Likert-scale. One PT case was caused by jugular occlusion (on the non-dominant side) and rerouting of the venous drainage.

Conclusions:
4D-CTA is a sensitive imaging modality for detection and characterization of venous stenoses. As 4D-CTA is less invasive and more available in smaller hospitals compared to DSA, it may serve as a better diagnostic sequence for improved detection of venous stenosis underlying pulsatile tinnitus. As we are still enrolling in the study, we plan to present more cases at the time of the conference.