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FUSION IMAGING TECHNOLOGY FOR INTRACRANIAL
VENOUS INVESTIGATION
Paolo Zamboni, MD
a
, Erica Menegatti, PhD
a
, Gisela Viselner MD
b
,
Fabrizio Calliada MD
c
, Stefano Bastianello,MD
b
.
a
Vascular Disease Center, University of Ferrara, Ferrara, Italy.
b
Fondazione Istituto Neurologico Nazionale Casimiro Mondino, Neuroradiological
Department, University of Pavia, Italy.
c
IRCCS Policlinico “S. Matteo”, Department of Radiology, University of Pavia, Italy
PURPOSE: Transcranial color coded sonography (TCCS), despite the poor definition
of the anatomical details, permits to investigate the cerebral venous flow in different
postural and respiratory conditions related to the physiology of cerebral venous return.
Usual TCCS windows do not permit to insonate the cavernous and petrosal sinuses. The
aim of this study is to investigate the possibility to insonate these sinuses through a
novel trans-cranial approach, the condylar window.
MATERIALS AND METHODS: We investigated 5 subjects by the means of fusion
imaging technology, an advanced ultrasonographic technique consistently used to
combine ultrasounds and MRI in different districts of the human body, but never used
for studying the brain circulation. Fiducial markers have been placed on the forefront of
each patient before the acquisition of MR brain imaging using a 1.5 T scanner.
Subsequently, the subjects underwent TCCS performed with the Esaote MyLab70XVG
ultrasound scanner equipped with Virtual Navigator technology. Venous circulation has
been investigated by using the classic trans-temporal window and the novel
transcondylar approach.
RESULTS: In all subjects fusion imaging technology demonstrates the possibility to
insonate the cavernous sinus and some of the petrosal sinuses through the condylar
window. In addition, the insonation of the Rosenthal and other parenchymal veins
through the classic trans-temporal window, never validated vs MRI in TCCS study, has
been confirmed by this technology.
CONCLUSION: The condylar window can be used for the study of intracranial deep
cerebral venous system and be useful in clinical practice.

Results
In healthy control subjects, the task evoked activation in an extensive set of brain areas
(task-positive network), including visual, parietal, temporal and frontal cortices. In MS
patients the task showed significantly reduced (30-70%) activations compared to normal
controls. The default (task-negative) network, in particular the medial prefrontal, posterior
cingulate and cuneus cortices, also showed pronounced differences in MS patientscompared to the normal controls. Specifically, these areas were not suppressed during task
performance in contrast to the expected suppression seen in the normal controls. The time
course of the BOLD response showed greater decay and a more pronounced undershoot as
compared to the control group. Venoplasty resulted in recovery of the task-negative effects
in the default network such that the comparison between controls and post-venoplasty MS
patients showed no significant differences (t-test, p<0.05). The pair wise t-test of pre- and
post-venoplasty activations confirmed that the default network suppression was increased
post-venoplasty as compared to pre-venoplasty in the same subjects. The task-positive
network on the other hand, did not show significant changes as a result of the procedure.