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World Neurosurg. 2019 Jul 19. pii: S1878-8750(19)32015-7. doi: 10.1016/j.wneu.2019.07.109. [Epub ahead of print]

A Novel Flow Dynamics Study of the Intracranial Veins Using Whole Brain Four-Dimensional Computed Tomography Angiography.

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Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan; Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France. Electronic address:
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.



The flow dynamics of the intracranial venous channels are fundamentally important for understanding intracranial physiology and pathophysiology. However, the method clinically applicable to the evaluation of the flow dynamics of the intracranial venous system has not been well described in the reported data. We have developed a new method to evaluate intracranial venous flow direction and velocity using 4-dimensional (4D) computed tomography angiography (CTA). The aim of the present study was to verify the accuracy and validity of 4D-CTA in a clinical setting.


We retrospectively analyzed 97 veins from 26 patients (16 cases of arteriovenous shunt disease, 9 intracranial tumor cases, and 1 cerebral aneurysm case) who had undergone both 4D-CTA and conventional digital subtraction angiography (DSA). Using 4D-CTA, we analyzed the time-density curve with gamma distribution extrapolation and obtained the direction of the flow and flow velocity of each vein. The direction of the flow in 4D-CTA was also collated with that obtained using conventional DSA to verify the experimental method.


The direction of the flow determined by 4D-CTA was consistent with that of conventional DSA in 94.8% of cases. The average venous flow velocity was 64.3 mm/second and 81.8 mm/second, respectively, in the antegrade and retrograde channels affected by arteriovenous shunts.


The present flow analysis using 4D-CTA enabled us to evaluate the direction and velocity of intracranial venous flow. Other than some limitations, the presented method is reliable and its potential for application in clinical settings is promising.


4D-CTA; Flow direction; Flow dynamics; Flow velocity; Intracranial vein


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