Research Reports - MRI evidence for altered venous drainage and intracranial compliance in mild traumatic brain injury

PLoS One. 2013;8(2):e55447

Pomschar A, Koerte I, Lee S, Laubender RP, Straube A, Heinen F, Ertl-Wagner B, Alperin N

PURPOSE: To compare venous drainage patterns and associated intracranial
hydrodynamics between subjects who experienced mild traumatic brain injury (mTBI)
and age- and gender-matched controls.
METHODS: Thirty adult subjects (15 with mTBI and 15 age- and gender-matched
controls) were investigated using a 3T MR scanner. Time since trauma was 0.5 to
29 years (mean 11.4 years). A 2D-time-of-flight MR-venography of the upper neck
was performed to visualize the cervical venous vasculature. Cerebral venous
drainage through primary and secondary channels, and intracranial compliance
index and pressure were derived using cine-phase contrast imaging of the cerebral
arterial inflow, venous outflow, and the craniospinal CSF flow. The intracranial
compliance index is the defined as the ratio of maximal intracranial volume and
pressure changes during the cardiac cycle. MR estimated ICP was then obtained
through the inverse relationship between compliance and ICP.
RESULTS: Compared to the controls, subjects with mTBI demonstrated a
significantly smaller percentage of venous outflow through internal jugular veins
(60.9±21% vs. controls: 76.8±10%; p = 0.01) compensated by an increased drainage
through secondary veins (12.3±10.9% vs. 5.5±3.3%; p<0.03). Mean intracranial
compliance index was significantly lower in the mTBI cohort (5.8±1.4 vs. controls
8.4±1.9; p<0.0007). Consequently, MR estimate of intracranial pressure was
significantly higher in the mTBI cohort (12.5±2.9 mmHg vs. 8.8±2.0 mmHg;
CONCLUSIONS: mTBI is associated with increased venous drainage through secondary
pathways. This reflects higher outflow impedance, which may explain the finding
of reduced intracranial compliance. These results suggest that hemodynamic and
hydrodynamic changes following mTBI persist even in the absence of clinical
symptoms and abnormal findings in conventional MR imaging.

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