| Morphological study of cerebral venous sinus in migraine patients based on 3D phase contrast magnetic resonance venographyBackground:The role of cerebral venous system in the pathogenesis of migraine deserves attention.Understanding the cerebral sinus morphology of migraine patients can better probe into the underlying pathophysiological changes of migraine exacerbation and chronicity,which may help us to discover new disease markers and even therapeutic targets.At present,most of the reported morphological studies of cerebral venous system were conducted on patients with chronic migraine(CM),and most of them used 2D time of flight magnetic resonance venography(2D-TOF MRV)to observe the transverse sinus.However,the anatomic variation rate of superior sagittal sinus and sinuses in migraine patients is rarely reported.The vary conclusions of these MRV-based cerebral venous sinus morphological studies greatly due to the differences in methods,terminology,and patient inclusion criteria.Therefore,it is necessary to have clear inclusion criteria,reliable examination methods and strict classification criteria when evaluating the cerebral venous morphology of migraine patients by magnetic resonance,so that we can define and describe the morphology of cerebral venous sinus more accurately.Objective:To investigate the variation and abnormality of cerebral venous sinus in patients with episodic migraine(EM)and chronic migraine(CM).Methods:Based on 3D phase contrast magnetic resonance venography,with tension type headache(TTH)patients as control,we investigated the variation of superior sagittal sinus,torcular herophili and transverse sinus in patients with episodic migraine and chronic migraine,and compared the score of transverse sinus stenosis among three groups.Results:There were no significant differences in age(F=2.381,P=0.099),gender(x2=2.312,P=0.315)and BMI(F=2.142,P=0.124)among EM,CM and TTH groups.Four anatomical variants of superior sagittal sinus were found in this study,with type I being the most common,including 34 cases(70.8%)in EM group,16 cases(94.1%)in CM group,and 14 cases(77.8%)in TTH group.There was no significant difference in the distribution of anatomic variation types among the three groups(x2=6.220,P=0.399).Seven of the nine types of torcular herophili anatomic variation were observed in this study,with type 1 and type 2 being the most common,followed by type 6.There was no significant difference in the distribution of each anatomic variation type among the three groups(x2=16.33,P=0.176).The proportion of transverse sinus asymmetry>50%was highest in CM group(11 cases,64.7%),followed by episodic migraine(25 cases,52%)and the TTH group(6 cases,33.4%),but there was no statistically significant difference among the three groups.The proportion of transverse sinus hypoplasia in CM group(8 cases,47.1%)was higher than that in EM group(9 cases,18.7%)(x2=5.209,P=0.05)and also higher than that in TTH group(3 cases,16.7%)(x2=3.747,P=0.053)but there was no significant statistical difference after correction.The stenosis rate of transverse sinus in CM group was higher than that in TTH group(x2=9.119,P=0.003),but there was no significant difference between EM and TTH(x2=2.447,P=0.118)or between CM and EM(x2=4.442,P=0.035).Scores of transverse sinus stenosis were significantly different among the three groups(KW=13.54,P=0.001).The scores of transverse sinus stenosis in the CM group were significantly higher than that in the EM group(U=232.5,P=0.007)and TTH group(U=51.0,P=0.005),but no significant difference was found between the EM group and the TTH group(U=319.5,P=0.083).Conclusion:The anatomical variation and pathological changes of cerebral venous sinus are common imaging findings in migraine patients and TTH patients.The incidence and severity of pathological changes such as transverse sinus stenosis are higher in migraine patients,especially in chronic migraine patients.Correlations between internal jugular vein ultrasonography results and transverse sinus morphology and investigation of abnormal morphology and hemodynamics of jugular vein in migraine patientsBackground:Transverse sinus stenosis and abnormal cervical venous flow dynamics are common imaging findings in patients with chronic and episodic migraines,though few studies have systematically evaluated.Some researchers proposed the venous hemodynamics anomaly severity score(VHISS)to evaluate the jugular vein function in migraine patients from two aspects of morphology and hemodynamics.However,the application of this standard is controversial,and several studies have questioned the accuracy and repeatability of this standard.In addition,the compliance of the internal jugular vein was evaluated by measuring the diameter and dilation of the internal jugular vein during Valsalva maneuver in migraine patients by ultrasound examination,and the function of the internal jugular vein valve was evaluated according to the time of venous valve regurgitation.The parameters of cervical venous blood flow are dynamic and closely related to respiration and body position,so it is difficult to quantify.Therefore,the application of these ultrasound methods and standards is controversial.Combing with previous literature,as the improvement of ultrasound technology,it is necessary to explore a standard and repeatable ultrasound diagnostic criteria for jugular vein abnormalities.Jugular vein morphology and hemodynamics have important clinical value in the evaluation and screening of abnormal changes of intracranial venous sinus in migraine patients.Objective:To evaluate the accuracy of internal jugular vein ultrasound parameters in the diagnosis of morphological changes of transverse sinus,and to investigate the abnormal changes of jugular vein morphology and hemodynamics in migraine patients.Methods:The patients underwent cerebral magnetic resonance examination and jugular vein ultrasound examination successively.Transverse sinus asymmetry and transverse sinus stenosis were evaluated.The ultrasound data of J2 segment of internal jugular vein and bilateral vertebral vein were recorded,including internal jugular vein area(CSA,cm2),time-average-mean velocity(TAMV,cm/s),during state of calm breathing,the end of deep inhalation and expiration.ROC analysis was used to evaluate the diagnostic accuracy of jugular vein ultrasound data(The ratio and difference of CSA and velocity of J2 segment under different respiratory conditions)for morphological changes of transverse sinus.The incidence of abnormal jugular drainage,jugular reflux,vertebral vein asymmetry and internal jugular vein asymmetry in migraine patients were investigated.Results:A total of 67 patients underwent both ultrasound and magnetic resonance examination,including 36 EM patients,14 CM patients and 17 TTH patients.There were no significant differences in age(F=2.944,P=0.060)and gender(x2=3.467,P=0.177)among the three groups.The rate of transverse sinus asymmetry in CM group was significantly higher than that in EM group and TTH group,but there was no significant statistical difference among the three groups(x2=2.972,P=0.226),The rate of transverse sinus stenosis in CM group was significantly higher than that in EM group and TTH group,and there was statistically significant difference between CM group and TTH group(x2=6.419,P=0.011),while no significant difference between EM group and CM group(x2=2.286,P=0.146)or TTH group(x2=2.425,P=0.110).There was significant difference in the score of transverse sinus stenosis between CM group and TTH group(U=47.5,P=0.003),but no significant difference between the EM group and CM group(U=117.5,P=0.089)or TTH group(U=215,P=0.063).ROC analysis showed that the ultrasonic parameters of left internal jugular vein for the diagnosis of left transverse sinus stenosis were as follows:CSA difference between the resting state and the end of deep inspiration(AUC=0.655,Youden index=0.361,cut-off=0.3 1 5 cm2,sensitivity=71.8%,specificity=64.3%).CSA difference between resting state and end expiratory(AUC=0.683,Youden index=0.468,cut-off=0.105cm2,sensitivity=71.8%,specificity=75.0%).CSA ratio of resting state to the end of deep inspiratory(AUC=0.654,Youden index=0.407,cut-off=1.17,sensitivity=69.2%,specificity=71.4%).The velocity difference between the end of inspiration and resting state(AUC=0.657,Youden index=0.365,cut-off=1.7cm/s,sensitivity=61.5%,specificity=75.0%).The ultrasound parameters of right internal jugular vein for predicting right transverse sinus stenosis were:CSA difference between the resting state and the end of deep inspiration(AUC=0.666,Youden index=0.290,cut-off=0.645 cm2,sensitivity=58.1%,specificity=70.8%);The velocity difference between the end of inspiration and the resting state(AUC=0.334,Youden index=0.290,cut-off=-0.645cm/s,sensitivity=70.8%,specificity=58.1%);The velocity difference between the end of expiratory and resting state(AUC=0.312,Youden index=0.383,cut-off=-8.05cm/s,sensitivity=70.8%,specificity=67.4%).The difference of bilateral internal jugular vein cross-sectional area(AUC=0.850,Youden index=0.638,cut-off=0.295 cm2,sensitivity=85.7%,specificity=78.1%)can be used as an ultrasound parameter to predict bilateral transverse sinus asymmetry>50%.Jugular vein ultrasound was performed in 89 patients,including 48 EM patients,17 CM patients,and 24 TTH patients.The rate of vertebral vein asymmetry in EM group was significantly higher than that in CM group(x2=8.816,P=0.002),while no significant difference between TTH group and CM group(x2=4.979,P=0.033)or EM group(x2=1.125,P=0.289).There were no significant differences in age(F=2.706,P=0.072)and gender(x2=1.960,P=0.375)among the three groups.There was no significant difference in the rate of internal jugular vein asymmetry and abnormal jugular drainage among the three groups.The incidence of jugular reflux in EM group was higher than that in the TTH group(x2=5.365,P=0.021),but there was no statistical significance after adjustment.There was no statistical difference in the incidence of jugular reflux between EM group and CM group(x2=0.082,P=1)or between the CM group and the TTH group(x2=3.484,P=0.141).Conclusion:Transverse sinus asymmetry or stenosis are common imaging changes in migraine patients.Combining with respiratory,ultrasound examination of internal jugular vein can screen morphological abnormalities of transverse sinus.Morphological and hemodynamic changes in jugular vein are more common in episodic migraine patients than chronic migraine patients.Associations between morphology of cerebral venous sinus and clinical characteristics in migraineursBackground:The underlying mechanisms of migraine exacerbation and chronicity are not fully elucidated.Chronic migraine is thought to involve a central mechanism of pain facilitation associated with high frequency of migraine attacks.Previous studies have suggested that increased frequency of migraine attacks may be associated with abnormal venous drainage.Transverse sinus stenosis is common in patients with chronic migraine(CM).In addition,CM patients also have a higher incidence of anatomic variation of transverse sinus.CM patients with hypoplasia of transverse sinus had higher consumption of analgesics,increased anxiety,and significantly increased systolic blood pressure,which are risk factors for chronic migraine.Evidently,the anatomic variation or pathological abnormality of cerebral venous sinus may cause the disorder of jugular drainage,involving in the onset and progression of migraine.Migraine attack is often accompanied by nausea,vomiting,photophobia,phonophobia,headache aggravation caused by physical activity and other non-headache symptoms.These symptoms appear from premonitory phase,reflect a wide range of neurological deficits.Some studies have reported that there is no correlation between the anatomic variation of transverse sinus on MRV and the clinical manifestations of migraine,such as the severity and frequency of headache.However,the relationship between pathological changes of transverse sinus and the clinical features of migraine,especially non-headache symptoms,has rarely been reported.The duration of migraine progress is vary among individuals,ranging from months to years,and not all episodic migraine(EM)will transformed into CM.Therefore,identifying risk factors associated with migraine exacerbation or chronicity can indicate important information on the underlying mechanisms.Objective:To investigate correlations between the anatomic variation or pathological changes of cerebral venous sinus and clinical features in migraineurs,and to analyze whether cerebral venous sinus morphological changes are risk factors of migraine exacerbation and chronicity.Methods:Based on 3D-PC-MRV and clinical questionnaire,this study analyzed the correlation between anatomic variation or pathological changes of transverse sinus and clinical features(including non-headache symptoms)in EM and CM patients.Risk factors of chronic migraine were analyzed by logistic regression.Kaplan-Meier method was used to describe the effects of transverse sinus stenosis and anatomic variation on migraine exacerbation.Cox regression was used to analyze the risk factors of migraine exacerbation.Results:Sixty-five migraine patients who completed MR were included in the analysis.There were 48 EM patients and 17 CM patients.No significant differences were found in age(t=0.199,P=0.843),gender(x2=0.112,P=0.738)and BMI(t=-0.639,P=0.533)between the groups of mild and severe transverse sinus asymmetry.There was no significant difference in the age of headache onset(t=-0.455,P=0.651),duration of headache(U=445,P=0.651),pain degree(VAS)(U=518,P=1.0)and non-headache symptoms such as fear of movement(x2=1.348,P=0.782)and aura(x2=0???,P=0.985).There were no significant differences in age(t=1.241,P=0.219),gender(x2=0.096,P=0.757)and BMI(t=-0.024,P=0.981)between groups with and without transverse sinus stenosis.There were no significant differences in age of headache onset(t=-1.578,P=0.120),duration of headache(U=453,P=0.898),VAS(U=342,P=0.085)and non-headache symptoms such as fear of movement(x2=1.396,P=0.237)and aura(x2=0.908,P=0.341)between the two groups.Binary logistic regression analysis showed that transverse sinus stenosis(OR=7.883,95%CI 1.515-53.968,P=0.035)and type ? superior sagittal sinus(OR=10.814,95%CI 1.139-102.659,P=0.038)are risk factors of chronic migraine.Transverse sinus asymmetry had no effect on migraine exacerbation(log-rank P=0.3492,HR=1.31,95%CI 0.75-2.29).The number of years from migraine onset to migraine exacerbation in the group with transverse sinus stenosis was significantly lower than that in the group without transverse sinus stenosis(Log-rank P=0.0013,HR=2.57,95%CI 1.45-4.58).Cox regression analysis showed that transverse sinus stenosis(HR=3.608,95%CI 1.683-7.736,P=0.001)and later onset age of migraine(HR=1.042,95%CI 1.009-1.076,P=0.013)were independent risk factors of migraine aggravation.Conclusion:Transverse sinus stenosis and type ? superior sagittal sinus are the risk factors of chronic migraine.Transverse sinus stenosis and later onset age of migraine are risk factors of migraine aggravation... |
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