scholarly journals The Relationships Among Transverse Sinus Stenosis Measured by CT Venography, Venous Trans-stenotic Pressure Gradient and Intracranial Pressure in Patients With Unilateral Venous Pulsatile Tinnitus

2021 ◽  
Vol 15 ◽  
Author(s):  
Xiaoyu Qiu ◽  
Pengfei Zhao ◽  
Xiaoshuai Li ◽  
Heyu Ding ◽  
Han Lv ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Pressure Gradient ◽  
Characteristic Curve ◽  
Transverse Sinus ◽  
Optimal Threshold ◽  
Pulsatile Tinnitus ◽  
Cross Sectional ◽  
Predictive Values ◽  
Non Invasive ◽  
Sinus Stenosis

ObjectivesTo assess a non-invasive means of predicting a venous trans-stenotic pressure gradient (TPG) and intracranial pressure (ICP) as opposed to invasive examinations in unilateral venous pulsatile tinnitus (PT) patients.MethodsThirty patients with unilateral venous PT who presented symptomatic-sided transverse sinus stenosis (TSS) on computed tomography venography (CTV), ipsilateral TPG measured by digital subtraction angiography (DSA) and cerebrospinal fluid (CSF) pressure measured by lumbar puncture were included. The ratio of TSS was calculated by dividing the cross-sectional areas of the maximal stenosed transverse sinus by that of the adjacent normal transverse sinus on CTV. The correlations among and predictive values of TSS, TPG, and ICP were analyzed.ResultsIn patients with unilateral venous PT, the symptomatic-sided and average bilateral TSS values were 78 ± 11 and 77 ± 9%; ICP, 230.50 ± 55.75 mmH2O; and the TPG, 9.51 ± 5.76 mmHg. The symptomatic-sided TSS was linearly and positively correlated with TPG (R2 = 0.400), and the symptomatic-sided and bilateral average TSS both showed weak correlations with ICP (R2 = 0.288, R′2 = 0.156). When the degree of TSS increased by 10%, the TPG and ICP increased by approximately 3.3 mmHg and 25.8 mmH2O, respectively. The receiver operating characteristic curve showed the optimal threshold of ipsilateral TSS for a positive TPG was 0.75, while TSS had no significant predictive value for ICP (p > 0.05). TPG and ICP also exhibited a linear positive correlation (R2 = 0.552). When ICP increased by 10 mmH2O, the TPG increased by approximately 0.77 mmHg, and the optimal threshold of ICP for a positive TPG was 227.5.ConclusionTSS, TPG, and ICP are interrelated. TSS measured by CTV can predict TPG in patients with unilateral venous PT.

scholarly journals CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies

2020 ◽  
Author(s):  
Pengfei Zhao ◽  
Heyu Ding ◽  
Han Lv ◽  
Xiaoshuai Li ◽  
Xiaoyu Qiu ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Transverse Sinus ◽  
Mean Value ◽  
Sigmoid Sinus ◽  
Pulsatile Tinnitus ◽  
Ct Venography ◽  
Sinus Wall ◽  
Key Points ◽  
Sinus Stenosis ◽  
Different Shapes

Abstract Objectives To investigate the correlation between transverse sinus stenosis (TSS) and transstenotic pressure gradient (TPG) in unilateral pulsatile tinnitus (PT) patients with sigmoid sinus wall anomalies (SSWA). Methods Fifty-seven patients with unilateral venous PT were retrospectively included. All of them underwent CT venography and catheter manometry, accompanied with SSWA. The degree, length, shape (intrinsic/extrinsic/dysplasia), location (proximal/middle/distal, referring to the relative position of TSS and the Labbé vein junction) of TSS, the types of SSWA (dehiscence/diverticulum), and the degree of transverse sinus outflow laterality were assessed, and the correlations with ipsilesional TPG were analyzed. Results The mean value of ipsilesional TPG was 7.61 ± 0.52 mmHg. The degree and length of ipsilesional TSS were positively correlated with TPG (p < 0.001, p’ < 0.001), respectively. TPG was significantly larger in patients with contralateral transverse sinus dysplasia than those without (p = 0.023) and significantly smaller in patients with ipsilesional sigmoid sinus diverticulum than those with isolated dehiscence (p = 0.001). No statistical difference in TPG was shown between ipsilesional TSSs of different shapes or locations (p > 0.05). No correlation was noted between the degree of ipsilesional transverse sinus outflow laterality and TPG (p = 0.051). Stepwise linear regression indicated that the degree (β = 9.207, 95% CI = 3.558–14.856), length (β = 0.122, 95% CI = 0.025–0.220) of ipsilesional TSS, and contralateral transverse sinus dysplasia (β = 1.875, 95% CI = 0.220–3.530) were significantly correlated with TPG (R2 = 0.471). Conclusions The degree, length of ipsilesional TSS, and contralateral transverse sinus dysplasia may be used to predict TPG in unilateral PT patients with SSWA. Key Points • CT venography may act as a screening tool to help low-probability unilateral pulsatile tinnitus (PT) patients with sigmoid sinus wall anomalies (SSWA) avoid invasive catheter manometry. • The degree and length of ipsilesional transverse sinus stenosis (TSS) are positively correlated with transtenotic pressure gradient (TPG) in unilateral PT patients with SSWA. • Ipsilesional TPG is larger in unilateral PT patients with contralateral transverse sinus dysplasia than those without and is smaller in unilateral PT patients with sigmoid sinus diverticulum than those with isolated dehiscence.

scholarly journals Transient resolution of venous sinus stenosis after high-volume lumbar puncture in a patient with idiopathic intracranial hypertension

2018 ◽  
Vol 129 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Thomas J. Buell ◽  
Daniel M. S. Raper ◽  
I. Jonathan Pomeraniec ◽  
Dale Ding ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Idiopathic Intracranial Hypertension ◽  
High Volume ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Pressure Gradients ◽  
Cross Sectional ◽  
Sinus Stenosis

Stenosis of the transverse sinus (TS) and sigmoid sinus (SS), with a trans-stenosis pressure gradient, has been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH). MRI has shown improvement in TS and SS stenosis after high-volume lumbar puncture (HVLP) in a subset of patients with IIH. The authors present the first report of an IIH patient with immediate post-HVLP TS and SS trans-stenosis pressure gradient reduction and an attendant increase in TS and SS cross-sectional area confirmed using intravascular ultrasonography (IVUS). Recurrence of the patient’s TS-SS stenosis coincided with elevated HVLP opening pressure, and venous sinus stent placement resulted in clinical improvement. This report suggests that TS and SS stenosis may be a downstream effect of elevated intracranial pressure in IIH, rather than its principal etiological mechanism. However, the authors hypothesize that endovascular stenting may obliterate a positive feedback loop involving trans-stenosis pressure gradients, and still benefit appropriately selected patients.

Venous stenting with concurrent intracranial pressure monitoring for the treatment of pseudotumor cerebri

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
Christopher R. Durst ◽  
R. Webster Crowley ◽  
Kenneth C. Liu
Keyword(s):  
Intracranial Pressure ◽  
Pressure Gradient ◽  
Pseudotumor Cerebri ◽  
Transverse Sinus ◽  
Intracranial Pressure Monitoring ◽  
Dural Sinus ◽  
Pressure Monitoring ◽  
Venous Stenting ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Increasing evidence supports dural venous sinus stenosis as the patho-etiology of pseudotumor cerebri (PTC) in a subset of affected patients. In this video, we demonstrate our technique for 1) diagnostic venous manometry to identify a flow-limiting stenosis of the transverse sinus in a PTC patient; and 2) successful treatment of the patient with venous stenting across the structural and physiological stricture in the dural sinus. The pressure gradient decreased from 20 mmHg pre-stent to 3 mmHg post-stent. In order to further quantify the effect of our intervention, concurrent intracranial pressure monitoring was performed.The video can be found here: http://youtu.be/auxRg17F8yI.

Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

2020 ◽  
Vol 130 (4) ◽  
pp. 1028-1033 ◽  
Author(s):  
Daniel Hewes ◽  
Robert Morales ◽  
Prashant Raghavan ◽  
David J. Eisenman
Keyword(s):  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Pulsatile Tinnitus ◽  
Sinus Wall ◽  
Sinus Stenosis

scholarly journals Platelet Count/Spleen Diameter Ratio as a Predictor of Esophageal Varices in Patients with Liver Cirrhosis

2017 ◽  
Vol 15 (2) ◽  
pp. 37-40
Author(s):  
Dipendra Khadka ◽  
Sudhamshu KC ◽  
Sandip Khadka ◽  
Kiran Regmi ◽  
Pooja KC
Keyword(s):  
Liver Cirrhosis ◽  
Platelet Count ◽  
Esophageal Varices ◽  
Complete Blood Count ◽  
Liver Function Tests ◽  
Cross Sectional Study ◽  
Diameter Ratio ◽  
Cross Sectional ◽  
Predictive Values ◽  
Non Invasive

Introduction: Upper gastro-intestinal endoscopy still remains the gold standard for screening of patients suspected to have esophageal varices but not without limitations. So, this study was conducted to access the diagnostic validity and correlation between non-invasive parameters like platelet count, spleen diameter and their ratio with esophageal varices (EV) in patients with liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function tests, liver ultrasound and UGI endoscopy were done for all patients included in the study to detect esophageal varices and the platelet count/spleen diameter (PC/SD) ratio was calculated and analyzed to determine whether it can predict the presence of esophageal varices or not. Results: Total patients of liver cirrhosis studied after exclusion were 191 EV was present in 125 patients (65.4%). The platelet count/spleen diameter ratio using a cutoff value of ≤ 909 to detect EV independent of the grade had 93% sensitivity and 100% specificity and positive and negative predictive values of 100% and 91% respectively. Conclusions: PC/SD ratio now can be used as a predictor of presence of esophageal varices in liver cirrhosis.

scholarly journals Comparing non-invasive diabetes risk scores for detecting patients in clinical practice: a cross-sectional validation study

2021 ◽  
Vol 4 ◽  
pp. 70
Author(s):  
Sinéad Flynn ◽  
Seán Millar ◽  
Claire Buckley ◽  
Kate Junker ◽  
Catherine Phillips ◽  
...  
Keyword(s):  
Risk Score ◽  
Characteristic Curve ◽  
Diabetes Risk ◽  
Detection Methods ◽  
Risk Scores ◽  
Continuous Variables ◽  
Irish Population ◽  
Cross Sectional ◽  
Non Invasive ◽  
Diabetes Risk Score

Background: Type 2 diabetes (T2DM) is a significant cause of morbidity and mortality, thus early identification is of paramount importance. A high proportion of T2DM cases are undiagnosed highlighting the importance of effective detection methods such as non-invasive diabetes risk scores (DRSs). Thus far, no DRS has been validated in an Irish population. Therefore, the aim of this study was to compare the ability of nine DRSs to detect T2DM cases in an Irish population. Methods: This was a cross-sectional study of 1,990 men and women aged 46–73 years. Data on DRS components were collected from questionnaires and clinical examinations. T2DM was determined according to a fasting plasma glucose level ≥7.0 mmol/l or a glycated haemoglobin A1c level ≥6.5% (≥48 mmol/mol). Receiver operating characteristic curve analysis assessed the ability of DRSs and their components to discriminate T2DM cases. Results: Among the examined scores, area under the curve (AUC) values ranged from 0.71–0.78, with the Cambridge Diabetes Risk Score (AUC=0.78, 95% CI: 0.75–0.82), Leicester Diabetes Risk Score (AUC=0.78, 95% CI: 0.75–0.82), Rotterdam Predictive Model 2 (AUC=0.78, 95% CI: 0.74–0.82) and the U.S. Diabetes Risk Score (AUC=0.78, 95% CI: 0.74–0.81) demonstrating the largest AUC values as continuous variables and at optimal cut-offs. Regarding individual DRS components, anthropometric measures displayed the largest AUC values. Conclusions: The best performing DRSs were broadly similar in terms of their components; all incorporated variables for age, sex, BMI, hypertension and family diabetes history. The Cambridge Diabetes Risk Score, had the largest AUC value at an optimal cut-off, can be easily accessed online for use in a clinical setting and may be the most appropriate and cost-effective method for case-finding in an Irish population.

scholarly journals Comparison of ELISA- and SIMOA-based quantification of plasma Aβ ratios for early detection of cerebral amyloidosis

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Steffi De Meyer ◽  
Jolien M. Schaeverbeke ◽  
Inge M. W. Verberk ◽  
Benjamin Gille ◽  
Maxim De Schaepdryver ◽  
...  
Keyword(s):  
Cost Effective ◽  
Cross Sectional Study ◽  
Amyloid Pet ◽  
Demographic Model ◽  
Characteristic Analysis ◽  
Cross Sectional ◽  
Predictive Values ◽  
Cerebral Amyloidosis ◽  
Non Invasive ◽  
Search Trial

Abstract Background Blood-based amyloid biomarkers may provide a non-invasive, cost-effective and scalable manner for detecting cerebral amyloidosis in early disease stages. Methods In this prospective cross-sectional study, we quantified plasma Aβ1–42/Aβ1–40 ratios with both routinely available ELISAs and novel SIMOA Amyblood assays, and provided a head-to-head comparison of their performances to detect cerebral amyloidosis in a nondemented elderly cohort (n = 199). Participants were stratified according to amyloid-PET status, and the performance of plasma Aβ1–42/Aβ1–40 to detect cerebral amyloidosis was assessed using receiver operating characteristic analysis. We additionally investigated the correlations of plasma Aβ ratios with amyloid-PET and CSF Alzheimer’s disease biomarkers, as well as platform agreement using Passing-Bablok regression and Bland-Altman analysis for both Aβ isoforms. Results ELISA and SIMOA plasma Aβ1–42/Aβ1–40 detected cerebral amyloidosis with identical accuracy (ELISA: area under curve (AUC) 0.78, 95% CI 0.72–0.84; SIMOA: AUC 0.79, 95% CI 0.73–0.85), and both increased the performance of a basic demographic model including only age and APOE-ε4 genotype (p ≤ 0.02). ELISA and SIMOA had positive predictive values of respectively 41% and 36% in cognitively normal elderly and negative predictive values all exceeding 88%. Plasma Aβ1–42/Aβ1–40 correlated similarly with amyloid-PET for both platforms (Spearman ρ = − 0.32, p <  0.0001), yet correlations with CSF Aβ1–42/t-tau were stronger for ELISA (ρ = 0.41, p = 0.002) than for SIMOA (ρ = 0.29, p = 0.03). Plasma Aβ levels demonstrated poor agreement between ELISA and SIMOA with concentrations of both Aβ1–42 and Aβ1–40 measured by SIMOA consistently underestimating those measured by ELISA. Conclusions ELISA and SIMOA demonstrated equivalent performances in detecting cerebral amyloidosis through plasma Aβ1–42/Aβ1–40, both with high negative predictive values, making them equally suitable non-invasive prescreening tools for clinical trials by reducing the number of necessary PET scans for clinical trial recruitment. Trial registration EudraCT 2009-014475-45 (registered on 23 Sept 2009) and EudraCT 2013-004671-12 (registered on 20 May 2014, https://www.clinicaltrialsregister.eu/ctr-search/trial/2013-004671-12/BE).

Comparing the accuracy of lay diagnosis of childhood malaria and pneumonia with that of the revised IMCI guidelines in Nigeria

2020 ◽  
Author(s):  
K O Elimian ◽  
P R Myles ◽  
R Phalkey ◽  
A Sadoh ◽  
C Pritchard
Keyword(s):  
Health Workers ◽  
Characteristic Curve ◽  
Cross Sectional Study ◽  
Childhood Diseases ◽  
Cross Sectional ◽  
Predictive Values ◽  
Benin City ◽  
Sensitivity Specificity ◽  
Childhood Malaria ◽  
Pneumonia Diagnosis

Abstract Background Improving caregivers’ recognition of childhood malaria and pneumonia is crucial to early treatment and improving outcomes. The objective of this study was to assess the accuracy and reliability of caregivers’ recognition of malaria and pneumonia (lay diagnosis) as compared to the revised IMCI guidelines. Methods A cross-sectional study design was used to recruit 903 children aged 2–59 months who were assessed for malaria and pneumonia by health workers at five primary healthcare centres in Benin City, Nigeria. Accuracy of lay diagnosis as compared to the revised IMCI guidelines was assessed using sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve (AUROC) values. Results The accuracy of caregivers’ ability to recognise malaria (AUROC: 0.60; 95% CI: 0.57–0.64) and pneumonia (AUROC: 0.54; 95% CI: 0.50–0.58) was, respectively, moderate and poor as compared to the IMCI guidelines. Caregivers were better able to identify children without than those with malaria and pneumonia. Agreement between caregivers and the IMCI guidelines for malaria and pneumonia diagnosis was poor (k = 0.14, 95% CI: 0.09–0.19; P = 0.0001). Conclusion Caregivers’ ability to recognise these childhood diseases as compared to the IMCI guidelines was poor overall, which was partly due to the approach used to ascertain lay diagnosis.

scholarly journals Transverse Sinus Stenosis in Venous Pulsatile Tinnitus Patients May Lead to Brain Perfusion and White Matter Changes

2021 ◽  
Vol 15 ◽  
Author(s):  
Xiaoshuai Li ◽  
Ning Xu ◽  
Xuxu Meng ◽  
Chihang Dai ◽  
Xiaoyu Qiu ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Perfusion ◽  
Structural Mri ◽  
Transverse Sinus ◽  
Pulsatile Tinnitus ◽  
Low Degree ◽  
Significant Difference ◽  
Sinus Stenosis ◽  
Brain Changes ◽  
High Degree

Objective: Transverse sinus stenosis (TSS) is associated with various symptoms, but whether it can lead to pathological brain changes is unclear. This study aimed to investigate brain changes in venous pulsatile tinnitus (PT) patients with TSS.Materials and Methods: In this study, fifty-five consecutive venous PT patients and fifty age- and gender-matched healthy controls (HCs) were investigated. In CT venography, the combined conduit score (CCS) was used to assess the degree of TSS in venous PT patients. Magnetic resonance venography was used to assess TSS in HCs. All the participants had undergone arterial spin labeling and structural MRI scans.Results: Two patients without TSS and ten HCs with TSS were excluded. Fifty-three venous PT patients with TSS and 40 HCs without TSS were included in this study. All the patients had unilateral cases: 16 on the left and 37 on the right. Based on the CCS, the patients were divided into high-degree TSS (a score of 1–2) (n = 30) and low-degree TSS groups (a score of 3–4) (n = 23). In the whole brain and gray matter, the patients with high-degree TSS showed decreased cerebral blood flow (CBF) compared with patients with low-degree TSS as well as HCs (P &lt; 0.05), and no significant difference in CBF was found in patients with low-degree TSS and HCs (P &gt; 0.05). In white matter (WM) regions, the patients with high-degree TSS exhibited decreased CBF relative to the HCs (P &lt; 0.05). The incidence of cloud-like WM hyperintensity was significantly higher in the above two patient groups than in the HC group (P &lt; 0.05).Conclusion: TSS in venous PT patients may lead to decreased CBF and cloud-like WM hyperintensity. These neuroimaging findings may provide new insights into pathological TSS in venous PT.

scholarly journals Cardiac acoustic biomarkers as surrogate markers to diagnose the phenotypes of pulmonary hypertension: an exploratory study

2021 ◽  
Author(s):  
Nobuhide Yamakawa ◽  
Norihiko Kotooka ◽  
Tomoyuki Kato ◽  
Tatsuhiko Kuroda ◽  
Koichi Node
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Characteristic Curve ◽  
Home Monitoring ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Predictive Values ◽  
Non Invasive ◽  
Phenotype Classification ◽  
Ambulatory Measurement

AbstractPulmonary hypertension (PH) is commonly associated with left heart disease. In this retrospective study, using the database of a clinical study conducted between January 2008 and July 2008, the phenotypes of PH were classified using non-invasive cardiac acoustic biomarkers (CABs) and compared with classification by echocardiography. Records with same-day measurement of acoustic cardiography and right heart catheterization (RHC) parameters were included; cases with congenital heart disease were excluded. Using the RHC measurements, PH was classified as pre-capillary PH (Prec-PH), isolated post-capillary PH (Ipc-PH), and combined pre-capillary and post-capillary PH (Cpc-PH). The first, second, third, and fourth heart sounds (S1, S2, S3, and S4) were quantified as CABs (intensity, complexity, and strength). Forty subjects were selected: 5 had Prec-PH, 5 had Ipc-PH, 8 had Cpc-PH, and 22 had No-PH. CABs were significantly correlated with RHC measurements, with significant differences among phenotypes. Phenotype classification was performed using various CABs, and the diagnostic performance as assessed by the area under the receiver operating characteristic curve was 0.674–0.720 for Prec-PH, 0.657–0.807 for Ipc-PH, and 0.742 for Cpc-PH. High negative and low positive predictive values for phenotype identification were observed. CABs may provide an ambulatory measurement method with home-monitoring friendliness which is more convenient than standard examinations to identify presence of PH and its phenotypes.

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