Retrograde blood flow in the internal jugular veins of humans with hypertension may have implications for cerebral arterial blood flow

• Published in: European radiology Vol. 30; no. 7; pp. 3890 - 3899
• Main Authors: Rodrigues, Jonathan C. L., Strelko, Galina, Warnert, Esther A. H., Burchell, Amy E., Neumann, Sandra, Ratcliffe, Laura E. K., Harris, Ashley D., Chant, Benjamin, Bowles, Ruth, Nightingale, Angus K., Wise, Richard G., Paton, Julian F. R., Hart, Emma C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2020; Springer Nature B.V
• Subjects: Blood flow; Brain; Cerebellum; Cerebral Arteries - physiopathology; Cerebral blood flow; Cerebrospinal fluid; Cerebrovascular Circulation - physiology; Daytime; Diagnostic Radiology; Female; Humans; Hypertension; Hypertension - physiopathology; Image segmentation; Imaging; Imaging, Three-Dimensional; Internal Medicine; Interventional Radiology; Jugular Veins - diagnostic imaging; Jugular Veins - physiopathology; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Modelling; Neuroimaging; Neuroradiology; Perfusion; Permutations; Phase contrast; Prospective Studies; Radiology; Spin labeling; Spin Labels; Statistical analysis; Substantia alba; Substantia grisea; Ultrasound; Variance analysis; Vascular-Interventional; Veins; Hypertension; Magnetic resonance imaging; Cerebral blood flow; MR angiography
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-06752-6

Objectives To use multi-parametric magnetic resonance imaging (MRI) to test the hypothesis that hypertensives would have higher retrograde venous blood flow (RVBF) in the internal jugular veins (IJV) vs. normotensives, and that this would inversely correlate with arterial inflow and gray matter, white matter, and cerebrospinal fluid volumes. Methods Following local institutional review board approval and written consent, a prospective observational 3-T MRI study of 42 hypertensive patients (53 ± 2 years, BMI 28.2 ± 0.6 kg/m 2 , ambulatory daytime systolic BP 148 ± 2 mmHg, ambulatory daytime diastolic BP 101 ± 2 mmHg) and 35 normotensive patients (48 ± 2 years, BMI 25.2 ± 0.8 kg/m 2 , ambulatory daytime systolic BP 119 ± 3 mmHg, ambulatory daytime diastolic BP 90 ± 2 mmHg) was performed. Phase contrast imaging calculated percentage retrograde venous blood flow (%RVBF), brain segmentation estimated regional brain volumes from 3D T1-weighted images, and pseudo-continuous arterial spin labeling measured regional cerebral blood perfusion. Statistical analysis included two-sample equal variance Student’s T tests, two-way analysis of variance with Tukey’s post hoc correction, and permutation-based two-group general linear modeling ( p  < 0.05). Results In the left IJV, %RVBF was higher in hypertensives (6.1 ± 1.5%) vs. normotensives (1.1 ± 0.3%, p  = 0.003). In hypertensives, there was an inverse relationship of %RVBF (permutation-based general linear modeling) to cerebral blood flow in several brain regions, including the left occipital pole and the cerebellar vermis ( p  < 0.01). Percentage retrograde flow in the left IJV correlated inversely with the total matter volume (gray plus white matter volume) in hypertensives ( r  = − 0.49, p  = 0.004). Conclusion RVBF in the left IJV is greater in hypertensives vs. normotensives and is linked to regional hypoperfusion and brain total matter volume. Key Points • Hypertensive humans have higher retrograde cerebral venous blood flow, associated with regional brain hypoperfusion and lower tissue volume, compared with controls. • Cerebral retrograde venous blood flow may add further stress to already hypoperfused tissue in hypertensive patients. • The amount of retrograde venous blood flow in hypertensive patients may predict which patients might be at higher risk of developing cerebral pathologies.