{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T05:07:31Z","timestamp":1783832851629,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100019065","name":"Tianjin Science and Technology Planning project","doi-asserted-by":"publisher","award":["21JCYBJC00880"],"award-info":[{"award-number":["21JCYBJC00880"]}],"id":[{"id":"10.13039\/501100019065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Venous pulsatile tinnitus (VPT) is associated with transverse\u2010sigmoid sinus (TSS) anomalies, bone dehiscence (BD), and hemodynamic disturbances. 4D Flow MRI enables comprehensive TSS evaluation, but causal relationships among TSS morphology, hemodynamics, and BD in VPT onset and progression remain unquantified. Reliable imaging predictors for VPT progression and BD's mediating role are unestablished.<\/jats:p>\n <\/jats:sec>\n \n Purpose<\/jats:title>\n To construct a directed acyclic graph (DAG) testing whether stenosis\u2010induced hemodynamic abnormalities and bone changes predict VPT occurrence and 6\u2010month progression.<\/jats:p>\n <\/jats:sec>\n \n Study Type<\/jats:title>\n Prospective longitudinal cohort study.<\/jats:p>\n <\/jats:sec>\n \n Population<\/jats:title>\n 126 unilateral VPT patients (36 [31\u201344] years; 73.0% female) and 83 matched non\u2010VPT participants (35 [28\u201342] years; 71.1% female); all VPT patients completed 6\u2010month symptom follow\u2010up.<\/jats:p>\n <\/jats:sec>\n \n Field Strength\/Sequence<\/jats:title>\n 3\u2009T multi\u2010shot turbo field echo 4D Flow MRI and fast field echo phase\u2010contrast MR venography (PC MRV).<\/jats:p>\n <\/jats:sec>\n \n Assessment<\/jats:title>\n Three blinded neuroradiologists independently assessed TSS morphology, hemodynamic indices, and petrous BD using PC MRV, 4D Flow MRI, and high\u2010resolution CT multiplanar reconstruction. Interobserver reliability was evaluated with discrepancies resolved by consensus.<\/jats:p>\n <\/jats:sec>\n \n Statistical Tests<\/jats:title>\n \n Kolmogorov\u2013Smirnov, Chi\u2010Square, Mann\u2013Whitney U test, FDR\u2010corrected correlation analysis, linear\/logistic regression, mediation analysis, and ROC curve analysis. Significance:\n p<\/jats:italic>\n \u2009<\u20090.05.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 74.6% of VPT patients had 6\u2010month progression (increased Tinnitus Handicap Inventory, THI score vs. baseline). Peak flow velocity (38.79\u2009cm\/s cut\u2010off) independently predicted 6\u2010month progression (area under the curve, AUC\u2009=\u20090.840; 95% confidence interval, CI: 0.755\u20130.925). TSS stenosis combined with hemodynamic parameters predicted VPT occurrence (AUC\u2009=\u20090.895, 95% CI: 0.855\u20130.936). Mediation analysis confirmed BD mediated the effect of wall shear stress on THI. Hierarchical causal pathways among TSS morphology, hemodynamics, BD, and VPT were identified to verify quantifiable DAG.<\/jats:p>\n <\/jats:sec>\n \n Data Conclusion<\/jats:title>\n TSS stenosis initiates hemodynamic disturbances and bone changes, which collectively drive VPT occurrence and 6\u2010month progression. Integrating these morphological and hemodynamic parameters yields accurate predictive models.<\/jats:p>\n <\/jats:sec>\n \n Evidence Level<\/jats:title>\n 4.<\/jats:p>\n <\/jats:sec>\n \n Technical Efficacy<\/jats:title>\n Stage 3.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jmri.70302","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:46:13Z","timestamp":1774341973000},"page":"359-373","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hemodynamic Mechanisms in Venous Pulsatile Tinnitus: A\n 4D<\/scp>\n Flow\n MRI<\/scp>\n Analysis of Transverse\u2010Sigmoid Sinus Abnormalities"],"prefix":"10.1002","volume":"64","author":[{"given":"Ke","family":"Lv","sequence":"first","affiliation":[{"name":"School of Medicine Nankai University Tianjin China"},{"name":"Department of Radiology Medical Imaging Institute of Tianjin, Tianjin First Central Hospital, School of Medicine, Nankai 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