I would think that if there was significant compression of the IJVs at the time of the scan it would show, but it could be possible that as they’re in close contact with the styloids, if you’re head is in certain positions then this could change the angle of the styloids and cause compression? As you suggest, this could be why your symptoms worsen with physical activity. I had bilateral IJV compression, my symptoms were worse with cycling,I think the physical activity increased blood flow & blood pressure, which then increased the intracranial hypertension and caused more symptoms of head pressure and off-balance feelings. Some members have found that the styloids are irritating the vagus nerve which can cause symptoms too, especially with exercise.
Hopefully if you post the images on here we can have a look- make sure you remove any personal info first though.
@borko2100 - you can upload your scans to dicomlibrary.com & it will anonymize them & give you a link you can share here so we can look at your images. Typically if there is IJV compression, it is caused by the IJV being squashed between the styloid(s) & transverse process of the C1 vertebra(e).
Thanks for the replies. I will upload my scan to the site you mentioned @Isaiah_40_31 later today.
In the meantime this is what I found:
On the left is my scan, on the right is an example I found of a compressed jugular vein from a study. The author says that the vein takes on a “pancake shape” as a result of the compression. What I can see on my scan is that the vein is indeed not round, but rather quite flat, not as bad as on the right, but still quite a similar appearance.
About the vagus nerve being compressed @Jules, this is for sure a very high possibility. I’ve compared my symptoms to what a dysfunctional vagus nerve might cause and it is quite similar picture. What struck me is the gastroparesis I saw mentioned, which is apparently a very common effect of a problem with the vagus nerve. When I experienced those worsenings I mentioned before, I would get this exact symptom of gastroparesis (i.e. very slow digestion, feeling full, etc.) and many others + most interestingly this pressure in my throat feeling would come back. Thankfully, the gastroparesis has gone now, but I still currently get other symptoms that indicate that something might be off with the vagus.
I agree that your left IJV looks compressed in the image you posted, @borko2100. I hope uploading your images to dicom library gives you some good 3D images so you can see the scenario a bit better.
@Isaiah_40_31 , dicomlibrary.com does not generate the 3D images. If there are 3D images pre-generated by the radiologist before writing to the CD, they will be simply displayed as far as I know, but the web tool doesn’t have capability to create 3D images from flat ones afaik.
Also, it doesn’t always fully anonymise the data which might be a critical thing for some people.
@vdm - Thx for the heads up. I didn’t realize that it didn’t create 3D images. I thought it did & that’s why we recommend uploading images there. Just goes to show how ignorant I am of how all this works.
I am aware that it doesn’t always do a good job of anonymization which somewhat defeats the purpose for using it.
I’m not sure who recommends uploading the images there, but the only reason to use the dicomlibrary service is to share the images with the wider audience for analysis instead of sending the files via some file transfer services like Google drive.
Also, the dicomlibrary service tries to remove as much of the personal information as possible from the electronically managed metadata fields, but if there are any scanned documents like requisition forms, reports etc.attached containing personal information, they will remain unchanged, e.g.will continue to carry the personal information, unless the person uploading the images manually chooses not to upload those series possibly containing the PII.
3D reconstruction from plain images is possible using specialized software, like RadiANT Viewer, 3D slicer, and similar. The reconstruction process is computing power intense, and requires a laptop/desktop computer though some software can give decent results on modern tablets/smartphones.
Also, if the radiologist prepares the 3D model while doing/reviewing the scan, and writes a few snapshots (plain images) of that 3D model onto the CD, then those snapshots are seen even without uploading the images anywhere, but rather the same way as the other series. But that doesn’t make them 3D model, as it can’t be sliced/rotated/diced like a real 3D model. It is simply what it is - a bunch of pre-recorded images the user can scroll between.
Update:
That’s why this forum desperately needs a concise FAQ that is kept up to date and acts as the first point for everyone to refer to, in order to avoid anecdotes that eventually become scattered across dozens of posts as cast in stone truth.
Yes, I agree your left IJV looks compressed. It looks larger than the right, so wonder if this is your dominant one (often people have a more dominant, larger IJV). The IJV on the right looks a little bit flattened too perhaps? Maybe it’s a bit compressed by something else?
I must retract my claim that dicomlibrary’s online viewer (which is powered by the meddream DICOM viewer) is not capable of generating 3D images from the flat ones.
Apparently (when not disabled) it allows to do that*. The image quality in the web browser might be decent enough to do basic investigation on top of sharing the original images with wider audience.
I’m more than happy to admit that I was wrong, as it makes one’s life in some cases much easier!! Also I owe an apology to @Isaiah_40_31 whom I criticized for spreading wrong information!!
*Under certain circumstances
@vdm - No worries and thank you for sharing your new knowledge. I appreciate knowing that what I understood about dicomlibrary’s purpose (besides anonymization) was correct.
No worries and thank you for sharing your new knowledge. I appreciate knowing that what I understood about dicomlibrary’s purpose (besides anonymization) was correct.
Honestly, I don’t think that anyone recommended dicomlibrary for the purpose of creating the 3D images (because the process of that is a bit clunky, quite limited, and the result is vastly inferior compared to proper image manipulation tools like RadiANT Viewer, 3D slicer and similar). All I say is that under certain circumstances (right browser, right hardware, right set of images) it is possible to create a very basic 3D model, therefore I must retract my claim that dicomlibrary is technically incapable of creating 3D models (because under certain conditions it is capable).
But I’m more than happy to admit I am wrong if someone can show me how to cut a piece of the scene out in the 3D model in dicomlibrary.
So for the future, & for technically challenged people like me, do we feel that the RadiANT viewer & 3D slicer are the best for creating images from CTs, but that for some the Dicomlibrary is easy to put images on & upload them? I don’t want to give wrong advice…
I uploaded the scan on the site you mentioned:
https://dicomlibrary.com?study=1.3.6.1.4.1.44316.6.102.3.2024030403025116.172267883199948091863
I also got a better picture of where I think the compression is:
It seems to me that the other (right) vein is also compressed, but for some reason it appears much less visible and thinner than the left one, so it is harder to tell what’s going on. Why could that be? Could the right vein just be naturally that much smaller? Or is it just because the contrast agent did not penetrate the other vein properly?
My personal opinion would be that
a) if someone wants to share their full studies or selected series of images with others, dicomlibrary is the easy and perhaps the best choice, but it’s important to be cautious and avoid uploading series containing personal identifying information, like requisitions, reports, consent forms and any other"paperwork".
It’s easy to use (just takes time to upload images), does decent job on removing as much as possible of that PII from metadata (electronic data fields containing textual data). It also has a convenient and good web-based viewer (though on a computer browser it looks better than on a mobile phone web browser), and what is useful, it allows to download (export) the full series so that others willing to help can not only check them on the web viewer, but also download and slice’n’dice them using more powerful programs (like 3D slicer, radiant viewer etc.)
It’s also possible to get a very basic 3D view rendering, though the tools to analyze it are limited (afaik you can’t slice a piece out of the model to isolate the region of interest, like cutting out the mandible to have proper view of the skull base with vascular structures still visible, but I might be wrong)
b) for 3D, there is a number of tools that can be used on desktop/laptop/mobile phone/tablet. Those programs allow to create 3D view and manipulate it, e.g. resect part of the bone that prevents from properly seeing the deeper structures. One of the easiest of them is Radiant Viewer, and has very intuitive/easy to use Scalpel tool. Especially on a computer with a touch screen, it becomes a breeze to move the model around and work on it. It’s commercial, however, but gives a decent trial period and allows to extend it. Works on Windows, and with some effort on Mac. Slicer 3D is another option, which personally I found more like a Makita power tool when all you need is to screw a screw in or hammer the nail. It takes a bit to learn how to use it, and the result might not always be that simple to achieve. But it’s free. And then there is a myriad of other, less know tools for mac, windows, linux, mobile phones, tablets, that have more or less advanced 3D rendering functions. I haven’t tried them though, so cannot comment.
Bottom line, from my personal perspective, is:
A) wanna just play with your scan images? Use the program included with the images in the CD (or USB)
B) wanna do proper analysis with 3D rendering? Use 3D slicer/radiant viewer/other programs capable of doing it
C) wanna share your images with other people and let them do (A) and/or (B) for you? Use dicomlibrary. Just be careful not to upload the series containing scanned paperwork.
Upd: some people somewhere else had relatively good results using Horos Mobile for iOS: Horos Mobile - Horos Project
I just want to add that several of our members have recommended the Bee Dicom Viewer App for Apple as an easier to use Dicom tool for creating 3D images of scans.
How does one do this? Is there a way to pull this information out of an upload to Dicom Library?
@borko2100 - It’s not uncommon for one IJV to be dominant i.e. larger & the other to be smaller & less significant. We’ve seen that frequently here. I’m guessing that’s the case w/ your IJVs though I can’t be sure w/o seeing some 3D images. I can see both of your IJVs are compressed in the CT slices (first images you posted) but can’t accurately tell you more w/o seeing a sagittal slice like the image on the right that you just posted or an image in the frontal plane that shows both jugulars.
By opening the images on the local computer using local program (either often included with the CD/UDB, or radiant viewer or similar), going quickly through all the series (it’s not that difficult to go through 5-25 series), checking which series have images and which have scanned paperwork, and not uploading those series with paperwork.
I uploaded the entire scan on the dicom library site:
https://dicomlibrary.com/?study=1.3.6.1.4.1.44316.6.102.3.2024030403025116.172267883199948091863
There you can see all the slices, sagital, frontal etc.
Unfortunately they did not do a 3D reconstruction, I will ask them if it is possible to make one with the data they have.
Here is a comparison of the left and right IJV. The right one (image on the left) looks exremely small and thin, I find it hard to believe it it could be that compressed, surely this must be a result of the scan not being accurate enough?
Veins, as compared to arteries, are very easily compressible because they don’t have a full muscular layer inside like arteries do, and their walls are quite thin.
For details, you can look for vein surgery videos on YouTube and see how easily they can be compressed by simply touching with finger.
As a real-world example, when you use your fingers to check the pulse on the neck, the same amount of pressure might completely cut off circulation in the IJV.