Asymmetric Petro-occipital Venous Plexus Thickening: A Valuable Diagnostic Sign of Reduced Flow in the ICA
Bibliographic record
Abstract
Thickening of the venous plexus surrounding the petrous ICA, known as Rektorzik venous plexus (RVP), is a marker of inward ICA remodeling from a substantial reduction in blood flow, but clinical application of its detection remains unexplored. We reviewed contrast-enhanced vessel wall MRI imaging (VWMRI) and CTA examinations of the head and neck acquired at our institutions to identify cases with asymmetric RVP thickening that influenced the diagnosis or medical management of neurovascular diseases. Five representative patients were included. Two patients with intracranial MRA or CTA interpreted as having normal findings had asymmetric RVP thickening, in one case leading to cervical imaging that identified high-grade carotid stenosis and in the other case drawing attention to a linear filling defect at the ipsilateral distal M1 branch of the MCA identified as a dissection on image reconstruction. The third patient had intracranial ICA stenosis not considered to be flow-limiting but the asymmetric RVP thickening suggested otherwise, which was supported by cervical ICA flow measurements by Doppler ultrasound. Two patients had resolution of asymmetric RVP thickening confirming flow restoration, one following treatment of intracranial vasospasm and the other after carotid revascularization. Asymmetric RVP thickening is a valuable biomarker that can identify flow-limiting stenosis, at times incidentally, and monitor changes in flow impairment, offering the potential for improved diagnostic accuracy and stroke-risk assessment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".