MRI scans show neckties cut blood flow to brain

By Brian Casey, staff writer

July 5, 2018 -- You now have another reason to hate neckties. German researchers using MRI discovered that neckties can constrict blood flow to the brain, according to a study published online June 30 in Neuroradiology.

White-collar professionals have always had plenty of reasons to dislike neckties, but the clinical impact of the neckwear has been less well-known. That began to change in the early 2000s, when researchers started analyzing the possible health risks, ranging from neckties as a vector for transmitting hospital-acquired infections to the possible effect of ties on intraocular pressure.

Dr. Robin Lüddecke and colleagues from University Hospital Schleswig-Holstein in Kiel speculated that tightening a necktie could restrict cerebral blood flow by compressing jugular venous flow. To investigate, they gathered 30 healthy young men with no known cerebrovascular disease and separated them into two groups: 15 were allowed to wear open-collared shirts, while 15 unlucky individuals were assigned to wear neckties.

MR images show changes in cerebral blood flow
MR images show changes in cerebral blood flow in healthy volunteers before, during, and after wearing a necktie. Courtesy of Dr. Robin Lüddecke.

Both groups received baseline MRI scans on a 3-tesla scanner (Achieva, Philips Healthcare). The control group received two more MRI scans, all without a necktie.

Each person in the experimental group underwent the baseline scan with an open collar and loosened necktie around his neck. The shirt collar was then closed and the necktie tightened for the second scan. Finally, for the third scan, the necktie was loosened and collar button opened.

The researchers used an arterial spin labeling (ASL) scanning protocol, with quantitative phase-contrast angiography performed over the jugular vein during a full RR cycle. Cerebral blood flow (CBF) was calculated and venous flow in the jugular vein was measured using software. CBF values were rendered as mL/min/100 g.

In the necktie group, cerebral blood flow dropped by 4.33 mL/min/100 g, or 7.5%, from the baseline scan to the second scan when the necktie was tightened. It was even lower at the third scan, 12.8% from baseline, after the necktie had been loosened. There were no statistically significant changes in CBF in the control group between the different scans.

Effect of neckties on cerebral blood flow on MRI scans
Cerebral blood flow No necktie group Necktie group Decline in CBF within necktie group
At baseline 59.68 58.02  
At 2nd scan 60.16 53.68 7.5%
At 3rd scan 58.19 50.61 12.8%
Values are mL/min/100 g. Differences within the necktie group were statistically significant.

On the other hand, the researchers found no statistically significant changes in flow in the jugular vein.

What caused the phenomenon? Cerebral blood flow is indirectly proportional to intracranial pressure, and compressing the jugular vein could lead to higher pressure by hindering outflow -- even in the absence of a change in jugular venous flow, they wrote. The declines in CBF were within physiological limits, so further research is needed to determine the clinical value of the findings, they added.

The study adds to the body of literature on the negative effects of wearing tight neckties, the researchers concluded. They noted that, fortunately, Palazzo and Hocken found in 2010 that patients do not expect doctors to wear neckties and white coats.

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Last Updated np 7/6/2018 10:05:41 AM

11 comments so far ...
7/8/2018 6:23:08 AM
This theory is completely obtuse. First of all, a man should be properly fitted for a dress shirt allowing the wearer a comfortable fit around the neck. The rule of thumb, generally, is the wearer should be able to insert a finger at the collar closure assuring that there is leeway for movement and that the collar is not too tight. Secondly, a tie should never be tied so tight as the wearer feels that it is a literal noose. If it is tied tightly then this theory would be correct to some degree. If a man is self-strangling with a noose-like tie perhaps there are other issues at hand that might require psychiatric attention.

7/8/2018 7:33:08 AM
I think they're saying that even a well fitting collar with tie cause measurable drop in bloodflow.

May not be significant, but it's still a drop.

It's like saying 50% carotid artery stenosis. It's not "clinically significant" but wouldn't you rather not have that?

7/8/2018 11:59:54 AM
Knob Creek Rye
Ties have been making me go borderline-vasovagal for years. Actually harmed some of my residency interview performances. I'm through with them, apart from weddings and similarly formal occasions.

7/8/2018 4:20:42 PM
So maybe radiologists who wear ties are not functioning optimally.

Ties are stupid anyway. Just gives potential criminals a nice handle with which to jerk you, hold and punch you or strangle you.

7/8/2018 4:58:29 PM
Knob Creek Rye
Random musing: those who are most insistent on residents wearing ties tend to be the ones who have no idea how to choose nice ties.