J Korean Soc Radiol.  2017 Dec;77(6):396-403. 10.3348/jksr.2017.77.6.396.

Physiologic Flow Related Signal Intensity in Dural Sinuses on Time of Flight Magnetic Resonance Angiography: Changes Caused by Head Elevation

• Roh J
• Baik SK
• Yeom JA
• Kim YS
• Jeong HS
• Yoon CH
• Han J

• KMID: 2396498
• DOI: http://doi.org/10.3348/jksr.2017.77.6.396

Abstract

PURPOSE
The presence of a flow-related signal in the normal dural sinus time of flight magnetic resonance angiography (TOF MRA) is common. This study aimed to identify changes in signal intensity in the dural sinus caused by changes in patient position.
MATERIALS AND METHODS
The researchers performed an elevation TOF MRA of the cerebral region in 52 patients, who showed abnormal flow-related signals in the dural sinuses on supine position. Flow-related signal intensity in the dural sinuses was then analyzed.
RESULTS
Flow-related signals were seen in 114 sites (52 patients), specifically in the internal jugular vein (IJV), sigmoid sinus (SS), inferior petrosal sinus (IPS), and cavernous sinus (CS) in 29 sites, 33 sites, 32 sites, and 20 sites, respectively. After head elevation, flow-related signal changes were then observed in the IJV, SS, IPS, and CS in 107 sites (107/114, 93.9%). There was loss of signal (62/114, 54.4%), or decrease (39/114, 34.2%), increase (6/114, 5.3%), or no change (7/114, 6.1%) in the signal intensity, and flow related signals were more frequent on the left than on the right.
CONCLUSION
Flow-related signals in the dural sinuses on TOF MRA were decreased or disappeared by head elevation in 88.6% of the sites. Head elevation may help distinguish between pathologic and physiologic states.

MeSH Terms

Cavernous Sinus
Cerebral Angiography
Cerebral Veins
Colon, Sigmoid
Diagnostic Imaging
Head*
Humans
Jugular Veins
Magnetic Resonance Angiography*
Magnetic Resonance Imaging
Supine Position

Figure

• 

  Fig. 1. TOF MRA images demonstrate subjective grade for the magnitude of any signal in left internal jugular vein. A. Grade 1, equal to that of normal dural sinus signal on an MRA source and/or MIP images. B. Grade 2, greater than the normal dural sinus signal and lesser than the internal carotid artery signal on an MRA source and/or MIP images (arrows). C. Grade 3, equal to that of internal carotid artery signal on an MRA source and/or MIP (arrows). MIP = maximum intensity projection, TOF MRA = time of flight magnetic resonance angiography

• 

  Fig. 2. Loss of flow-related signal on TOF MRA. A. TOF MRA in supine position (small box in left lower image). The flow-related signals are seen on the left side of the internal jugular vein, sig-moid sinus, inferior petrosal sinus, and cavernous sinus (arrows) on TOF MRA. B. TOF MRA in supine position with head elevation (small box in left lower image). After head elevation, the flow-related signals in the left dural sinuses disappear. TOF MRA = time of flight magnetic resonance angiography

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