A Brain Region-Based Deep Medullary Veins Visual Score on Susceptibility Weighted Imaging.

Ruiting Zhang,Xinfeng Yu,Ruirui Song,Yerfan Jiaerken,Shenqiang Yan,Minming Zhang,Ying Zhou,Genlong Zhong,Chang Liu,Min Lou

doi:10.3389/fnagi.2017.00269

Ruiting Zhang, Xinfeng Yu + Show 8 more

Open Access

https://doi.org/10.3389/fnagi.2017.00269

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Abstract

Cerebral venous collagenosis played a role in the pathogenesis of white matter hyperintensities (WMHs) through venous ischemia. Since pathological changes of veins from intramural stenosis to luminal occlusion is a dynamic process, we aimed to create a deep medullary veins (DMVs) visual grade on susceptibility-weighted images (SWI) and explore the relationship of DMVs and WMHs based on venous drainage regions. We reviewed clinical, laboratory and imaging data from 268 consecutive WMHs patients and 20 controls. SWI images were used to observe characteristics of DMVs and a brain region-based DMVs visual score was given by two experienced neuroradiologists. Fluid attenuated inversion recovery (FLAIR) images were used to calculate WMHs volume. Logistic-regression analysis and partial Pearson’s correlation analysis were used to examine the association between the DMVs score and WMHs volume. We found that the DMVs score was significantly higher in WMHs patients than in controls (p < 0.001). Increased DMVs score was independently associated with higher WMHs volume after adjusting for total cholesterol level and number of lacunes (p < 0.001). Particularly, DMVs scores were correlated with regional PVHs volumes in the same brain region most. The newly proposed DMVs grading method allows the clinician to monitor the course of DMVs disruption. Our findings of cerebral venous insufficiency in WMHs patients may help to elucidate the pathogenic mechanisms and progression of WMHs.

Highlights

White matter hyperintensities (WMHs), known as leukoaraiosis, are commonly seen as confluent or patchy hyperintense areas on T2 weighted or fluid attenuated inversion recovery (FLAIR) scans in the elderly (Wardlaw et al, 2013)
We proposed a novel visual deep medullary veins (DMVs) score based on brain lobes
We found an independent association between DMVs score and cWMHs volume, especially PVHs volume

Summary

Introduction

White matter hyperintensities (WMHs), known as leukoaraiosis, are commonly seen as confluent or patchy hyperintense areas on T2 weighted or fluid attenuated inversion recovery (FLAIR) scans in the elderly (Wardlaw et al, 2013). The presence of WMHs is associated with cognitive impairment and mood disorders, increases the risk of stroke, dementia and mortality (Kim et al, 2008; Debette and Markus, 2010). DMVs Visual Score and WMHs fluid circulation, with consequent vessel leakage (Moody et al, 1995; Black et al, 2009). Yan et al (2014) demonstrated increased number of voxels of deep medullary veins (DMVs) on susceptibility-weighted imaging (SWI) was independently associated with WMHs volume. Guio et al (De Guio et al, 2014) observed a significant reduction in the number of visible veins within WMHs in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

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