Compression of the left brachiocephalic vein: cause of high signal intensity of the left sigmoid sinus and internal jugular vein on MR images

To study the asymmetry in signal intensity of the sigmoid sinuses, internal jugular veins (IJVs), or both sets of structures on magnetic resonance (MR) images, the authors reviewed 226 serial sets of routine MR imaging studies. Cerebral digital subtraction angiography was performed in 20 patients with a markedly higher intensity and/or enhancement on the left; 15 of them also underwent venography. With every sequence, the left sigmoid sinus, IJV, or both were higher in signal intensity significantly more often than the right (range, P = .0001 to .0129). Angiography revealed hemostasis in the left IJV in 16 patients that disappeared during full inspiration in 14. In 13, venography revealed that the left brachiocephalic vein was compressed to occlusion between the aortic arch and the sternum during tidal volume ventilation. The occlusion disappeared at full inspiration, when the distance between the aortic arch and the sternum increased. This hemostasis could be the major cause of the frequent increased signal intensity of the left sigmoid sinus and IJV on MR images.