Observing Reduced Venous Flow in Migraine Patients Using MRI

This week’s article is regarding phase-contrast flow quantification, a rapid, non-invasive MR sequence which can provide hemodynamic information such as velocity profiles and flow rates in the large and small vessels. Clinically, it may be used to determine if flow is blocked in arteries that lead to the brain such as the carotid and vertebral, or if flow is insufficient or retrograde, which have been associated with various neurological conditions.  Specifically in this article, the sequence was used to evaluate intracranial and cervical venous flow in a cohort of migraine patients.

Altered cerebrovenous drainage in patients with migraine as assessed by phase-contrast magnetic resonance imaging. Koerte, et al. Investigative Radiology. 2011.

A head MRI phase-contrast blood flow study was conducted on 26 Migraine patients and age and gender matched healthy controls. The scan was conducted at two different encoding speeds in order to accommodate both high and low velocity blood flow (Venc= 70cm/s vs Venc= 7-9cm/s). High velocity flow was recorded for the internal carotid arteries, ventricular arteries, and internal jugular veins. Vertebral veins, epidural veins, and deep cervical veins were considered as secondary venous pathways and were evaluated at the low velocity venc. No other veins were evaluated, making any cerebral blood flow not drained by the four veins evaluated unmeasured secondary venous outflow. 

Example of high and low VENC phase-contrast images from a healthy subject (left) and a subject with migraine (right). A, B, Flow compensated magnitude images showing the bright signal from blood vessels. The augmented venous outflow through the epidural (short white arrows), vertebral veins (long white arrows), and the deep cervical veins (arrow heads) is clearly visualized. C, D, High-velocity encoding images used for measurements of arterial inflow and venous outflow through the jugular veins. E, F, Low-velocity encoding images used for measurements of the flow through the secondary channels (epidural, vertebral, and deep cervical veins). The lumen boundaries (red - arteries, and blue - veins) were identified using the PUBS automated segmentation method.

The results showed a higher percentage of increased secondary venous drainage in Migraine patients, accompanied by and lower jugular flow when compared to controls.

This change is statistically significant when comparing the two groups quantitatively. In addition, the Migraine group contained a larger subset of individuals with dense secondary extracranial venous networks (15/26 vs. 2/26). These findings were believed to be the result of regulation of cerebral hemodynamics, possibly as a result of vasoactive substances such as calcitonin gene-related peptide and substance P, which are evidently common products in Migraine patients.

Derived volumetric flow waveforms obtained from a healthy subject (left) and a subject with migraine (right). Total arterial inflow (TCBF) and total venous outflow through the jugular veins are shown in the top (A and B). The measured venous flow through the epidural veins is shown in C and D, respectively.

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MR Innovations is on the cutting edge of flow quantification. For more information on flow quantification and MRI post-processing software and analysis, please visit www.mrinnovations.com.

References:

1.  Koerte IK, Schankin CJ, et al.   Altered cerebrovenous drainage in patients with migraine as assessed by phase-contrast magnetic resonance imaging.  Invest Radiol. 2011 Jul;46(7):434-40. doi: 10.1097/RLI.0b013e318210ecf5.