Reflux venous flow in dural sinus and internal jugular vein on 3D time-of-flight MR angiography

Introduction

Reflux venous signal on the brain and neck time-of-flight magnetic resonance angiography (TOF MRA) is thought to be related to a compressed left brachiocephalic vein. This study is aimed to assess the prevalence of venous reflux flow in internal jugular vein (IJV), sigmoid sinus/transverse sinus (SS/TS), and inferior petrosal sinus (IPS) on the brain and neck TOF MRA and its pattern.

Methods

From the radiology database, 3,475 patients (1,526 men, 1,949 women, age range 19–94, median age 62 years) with brain and neck standard 3D TOF MRA at 3 T and 1.5 T were identified. Rotational maximal intensity projection images of 3D TOF MRA were assessed for the presence of reflux flow in IJV, IPS, and SS/TS.

Results

Fifty-five patients (1.6 %) had reflux flow, all in the left side. It was more prevalent in females (n?=?43/1,949, 2.2 %) than in males (n?=?12/1,526, 0.8 %) (p?=?0.001). The mean age of patients with reflux flow (66 years old) was older than those (60 years old) without reflux flow (p?=?0.001). Three patients had arteriovenous shunt in the left arm for hemodialysis. Of the remaining 52 patients, reflux was seen on IJV in 35 patients (67.3 %). There were more patients with reflux flow seen on SS/TS (n?=?34) than on IPS (n?=?25).

Conclusion

Venous reflux flow on TOF MRA is infrequently observed, and reflux pattern is variable. Because it is exclusively located in the left side, the reflux signal on TOF MRA could be an alarm for an undesirable candidate for a contrast injection on the left side for contrast-enhanced imaging study.