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Incidence of vascular anomalies and variants associated with unilateral venous pulsatile tinnitus in 242 patients based on dual-phase contrast-enhanced computed tomography.

Dong C, Zhao PF, Yang JG, Liu ZH, Wang ZC - Chin. Med. J. (2015)

Bottom Line: A comprehensive assessment of various vascular anomalies and variants associated with venous pulsatile tinnitus (PT) by radiography is essential for therapeutic planning and improving the clinical outcome.The number of anomalies and variants on the symptomatic side in each patient was calculated. (1) A total 170 patients (170/242) had more than one anomaly or variant on the symptomatic side, and 58 patients (58/242) had a single lesion on tomography. (2) There was a statistically significant difference in the incidence of dehiscent sigmoid plate (P = 0.000), lateral sinus stenosis (P = 0.014), high jugular bulb (P = 0.000), sigmoid sinus diverticulum (P = 0.000), jugular bulb diverticulum (P = 0.000), dehiscent jugular bulb (P = 0.000), and a large emissary vein (P = 0.006) between the symptomatic and asymptomatic sides. (3) Dehiscent sigmoid plate (86.4%) was the most frequent lesion on the symptomatic side, followed by lateral sinus stenosis (55.8%), high jugular bulb (47.1%), sigmoid sinus diverticulum (34.3%), jugular bulb diverticulum (13.6%), dehiscent jugular bulb (13.6%), large emissary vein (4.1%), sinus thrombosis (1.2%), and petrosquamosal sinus (0.8%).Various vascular anomalies and variants occur more frequently on the venous PT side.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100000, China.

ABSTRACT

Background: A comprehensive assessment of various vascular anomalies and variants associated with venous pulsatile tinnitus (PT) by radiography is essential for therapeutic planning and improving the clinical outcome. This study evaluated the incidence of various vascular anomalies and variants on the PT side and determined whether these lesions occurred as multiple or single entities.

Methods: The dual-phase contrast-enhanced computed tomography images of 242 patients with unilateral venous PT were retrospectively reviewed. The vascular anomalies and variants on the symptomatic and asymptomatic sides were analyzed, and the incidences of anomalies or variants on each side were compared. The number of anomalies and variants on the symptomatic side in each patient was calculated.

Results: (1) A total 170 patients (170/242) had more than one anomaly or variant on the symptomatic side, and 58 patients (58/242) had a single lesion on tomography. (2) There was a statistically significant difference in the incidence of dehiscent sigmoid plate (P = 0.000), lateral sinus stenosis (P = 0.014), high jugular bulb (P = 0.000), sigmoid sinus diverticulum (P = 0.000), jugular bulb diverticulum (P = 0.000), dehiscent jugular bulb (P = 0.000), and a large emissary vein (P = 0.006) between the symptomatic and asymptomatic sides. (3) Dehiscent sigmoid plate (86.4%) was the most frequent lesion on the symptomatic side, followed by lateral sinus stenosis (55.8%), high jugular bulb (47.1%), sigmoid sinus diverticulum (34.3%), jugular bulb diverticulum (13.6%), dehiscent jugular bulb (13.6%), large emissary vein (4.1%), sinus thrombosis (1.2%), and petrosquamosal sinus (0.8%).

Conclusions: Various vascular anomalies and variants occur more frequently on the venous PT side. Preliminary findings suggest that venous PT patients may have multiple vascular anomalies or variants on the symptomatic side.

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Various vascular anomalies and variants of venous pulsatile tinnitus detected on venous phase computed tomography (CT) images in this study. Axial CT image; (a) Sigmoid sinus diverticulum (arrow) accompanying with a dehiscent sigmoid plate (arrowhead). Axial CT image; (b) A stenosis in right transverse sinus (arrow). Axial CT image; (c) A high jugular bulb (arrow) and axial CT image; (d) A right jugular bulb dehiscence (arrow). Coronal CT image; (e) A jugular bulb diverticulum (arrow). Sagittal CT image; (f) A petrosquamosal sinus running into the temporal bone (arrow). Axial CT image; (g) A filling defect (thrombosis) in the superior curve of right sigmoid sinus (arrow). Axial CT image; (h) A large emissary vein (arrow).
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Figure 1: Various vascular anomalies and variants of venous pulsatile tinnitus detected on venous phase computed tomography (CT) images in this study. Axial CT image; (a) Sigmoid sinus diverticulum (arrow) accompanying with a dehiscent sigmoid plate (arrowhead). Axial CT image; (b) A stenosis in right transverse sinus (arrow). Axial CT image; (c) A high jugular bulb (arrow) and axial CT image; (d) A right jugular bulb dehiscence (arrow). Coronal CT image; (e) A jugular bulb diverticulum (arrow). Sagittal CT image; (f) A petrosquamosal sinus running into the temporal bone (arrow). Axial CT image; (g) A filling defect (thrombosis) in the superior curve of right sigmoid sinus (arrow). Axial CT image; (h) A large emissary vein (arrow).

Mentions: All CT images were individually evaluated by three radiologists with 5, 6, and 11 years of experience. All findings were determined by consensus. The vascular anomalies and variants on symptomatic and asymptomatic sides were analyzed and evaluated retrospectively. These evaluated vascular anomalies and variants were diagnosed on the following previously described criteria [Figure 1]: (1) High jugular bulb, the jugular bulb extended above the inferior border of the round window;[1] (2) dehiscent jugular bulb or dehiscent sigmoid plate, the incomplete thin bone around the jugular bulb or the sigmoid sinus;[410] (3) jugular bulb diverticulum, prominent protrusion or an irregular out-pouching of jugular bulb that was clearly distinguished from a smooth ellipsoidal form;[22] (4) sigmoid sinus diverticulum, a diverticulum entered into the mastoid bone;[9] (5) lateral sinus stenosis, the L/S ratio (L = the largest area of the vein; S = the smallest area of the vein) was >4.75;[11] (6) large emissary vein, diameter of the emissary veins was >3.5 mm;[12] (7) petrosquamosal sinus, embryologic emissary vein running along the petrosquamosal Fissure;[15] and (8) sinus thrombosis, signs of thrombosis were noted, including the empty δ-sign or an irregular filling defect.[23] These anomalies and variants were analyzed in each patient and summed.


Incidence of vascular anomalies and variants associated with unilateral venous pulsatile tinnitus in 242 patients based on dual-phase contrast-enhanced computed tomography.

Dong C, Zhao PF, Yang JG, Liu ZH, Wang ZC - Chin. Med. J. (2015)

Various vascular anomalies and variants of venous pulsatile tinnitus detected on venous phase computed tomography (CT) images in this study. Axial CT image; (a) Sigmoid sinus diverticulum (arrow) accompanying with a dehiscent sigmoid plate (arrowhead). Axial CT image; (b) A stenosis in right transverse sinus (arrow). Axial CT image; (c) A high jugular bulb (arrow) and axial CT image; (d) A right jugular bulb dehiscence (arrow). Coronal CT image; (e) A jugular bulb diverticulum (arrow). Sagittal CT image; (f) A petrosquamosal sinus running into the temporal bone (arrow). Axial CT image; (g) A filling defect (thrombosis) in the superior curve of right sigmoid sinus (arrow). Axial CT image; (h) A large emissary vein (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834766&req=5

Figure 1: Various vascular anomalies and variants of venous pulsatile tinnitus detected on venous phase computed tomography (CT) images in this study. Axial CT image; (a) Sigmoid sinus diverticulum (arrow) accompanying with a dehiscent sigmoid plate (arrowhead). Axial CT image; (b) A stenosis in right transverse sinus (arrow). Axial CT image; (c) A high jugular bulb (arrow) and axial CT image; (d) A right jugular bulb dehiscence (arrow). Coronal CT image; (e) A jugular bulb diverticulum (arrow). Sagittal CT image; (f) A petrosquamosal sinus running into the temporal bone (arrow). Axial CT image; (g) A filling defect (thrombosis) in the superior curve of right sigmoid sinus (arrow). Axial CT image; (h) A large emissary vein (arrow).
Mentions: All CT images were individually evaluated by three radiologists with 5, 6, and 11 years of experience. All findings were determined by consensus. The vascular anomalies and variants on symptomatic and asymptomatic sides were analyzed and evaluated retrospectively. These evaluated vascular anomalies and variants were diagnosed on the following previously described criteria [Figure 1]: (1) High jugular bulb, the jugular bulb extended above the inferior border of the round window;[1] (2) dehiscent jugular bulb or dehiscent sigmoid plate, the incomplete thin bone around the jugular bulb or the sigmoid sinus;[410] (3) jugular bulb diverticulum, prominent protrusion or an irregular out-pouching of jugular bulb that was clearly distinguished from a smooth ellipsoidal form;[22] (4) sigmoid sinus diverticulum, a diverticulum entered into the mastoid bone;[9] (5) lateral sinus stenosis, the L/S ratio (L = the largest area of the vein; S = the smallest area of the vein) was >4.75;[11] (6) large emissary vein, diameter of the emissary veins was >3.5 mm;[12] (7) petrosquamosal sinus, embryologic emissary vein running along the petrosquamosal Fissure;[15] and (8) sinus thrombosis, signs of thrombosis were noted, including the empty δ-sign or an irregular filling defect.[23] These anomalies and variants were analyzed in each patient and summed.

Bottom Line: A comprehensive assessment of various vascular anomalies and variants associated with venous pulsatile tinnitus (PT) by radiography is essential for therapeutic planning and improving the clinical outcome.The number of anomalies and variants on the symptomatic side in each patient was calculated. (1) A total 170 patients (170/242) had more than one anomaly or variant on the symptomatic side, and 58 patients (58/242) had a single lesion on tomography. (2) There was a statistically significant difference in the incidence of dehiscent sigmoid plate (P = 0.000), lateral sinus stenosis (P = 0.014), high jugular bulb (P = 0.000), sigmoid sinus diverticulum (P = 0.000), jugular bulb diverticulum (P = 0.000), dehiscent jugular bulb (P = 0.000), and a large emissary vein (P = 0.006) between the symptomatic and asymptomatic sides. (3) Dehiscent sigmoid plate (86.4%) was the most frequent lesion on the symptomatic side, followed by lateral sinus stenosis (55.8%), high jugular bulb (47.1%), sigmoid sinus diverticulum (34.3%), jugular bulb diverticulum (13.6%), dehiscent jugular bulb (13.6%), large emissary vein (4.1%), sinus thrombosis (1.2%), and petrosquamosal sinus (0.8%).Various vascular anomalies and variants occur more frequently on the venous PT side.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100000, China.

ABSTRACT

Background: A comprehensive assessment of various vascular anomalies and variants associated with venous pulsatile tinnitus (PT) by radiography is essential for therapeutic planning and improving the clinical outcome. This study evaluated the incidence of various vascular anomalies and variants on the PT side and determined whether these lesions occurred as multiple or single entities.

Methods: The dual-phase contrast-enhanced computed tomography images of 242 patients with unilateral venous PT were retrospectively reviewed. The vascular anomalies and variants on the symptomatic and asymptomatic sides were analyzed, and the incidences of anomalies or variants on each side were compared. The number of anomalies and variants on the symptomatic side in each patient was calculated.

Results: (1) A total 170 patients (170/242) had more than one anomaly or variant on the symptomatic side, and 58 patients (58/242) had a single lesion on tomography. (2) There was a statistically significant difference in the incidence of dehiscent sigmoid plate (P = 0.000), lateral sinus stenosis (P = 0.014), high jugular bulb (P = 0.000), sigmoid sinus diverticulum (P = 0.000), jugular bulb diverticulum (P = 0.000), dehiscent jugular bulb (P = 0.000), and a large emissary vein (P = 0.006) between the symptomatic and asymptomatic sides. (3) Dehiscent sigmoid plate (86.4%) was the most frequent lesion on the symptomatic side, followed by lateral sinus stenosis (55.8%), high jugular bulb (47.1%), sigmoid sinus diverticulum (34.3%), jugular bulb diverticulum (13.6%), dehiscent jugular bulb (13.6%), large emissary vein (4.1%), sinus thrombosis (1.2%), and petrosquamosal sinus (0.8%).

Conclusions: Various vascular anomalies and variants occur more frequently on the venous PT side. Preliminary findings suggest that venous PT patients may have multiple vascular anomalies or variants on the symptomatic side.

Show MeSH
Related in: MedlinePlus