MRI Evidence for Altered Venous Drainage and Intracranial Compliance in Mild Traumatic Brain InjuryReport as inadecuate

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To compare venous drainage patterns and associated intracranial hydrodynamics between subjects who experienced mild traumatic brain injury mTBI and age- and gender-matched controls.


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.


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; p<0.0007.


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.

Author: Andreas Pomschar, Inga Koerte, Sang Lee, Ruediger P. Laubender, Andreas Straube, Florian Heinen, Birgit Ertl-Wagner, Noam Alperin



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