Increased Visibility of Deep Medullary Veins in Leukoaraiosis: A 3-T MRI Study

Cerebral venous collagenosis has been implicated in leading to white matter hyperintensities (WMHs) via venous ischemia. We sought to determine whether cerebral venous dilation or ischemia correlate with the severity of WMHs by quantitative in vivo imaging techniques. This was an investigator-initiated prospective single-center study. We reviewed clinical, laboratory data from 158 consecutive WMHs patients and 50 controls, and measured the number of voxels of deep medullary veins (DMVs) on susceptibility-weighted image and assessed the WMH volume (as a marker of the severity of WMHs) on a 3-T magnetic resonance system. We then performed the logistic-regression analysis and partial Pearson’s correlation analysis to examine the association between the venous voxel count and WMH volume. The number of voxels of DMVs was significantly higher in WMHs than in controls. Increased number of voxels of DMVs was independently associated with both WMH volume of the whole brain and coregistered regional WMH volume after adjusting for age and number of lacunes. Our study indicates that cerebral deep venous insufficiency or ischemia play a role in the pathogenesis of WMHs, which may provide prognostic information on patients with WMHs and may have implications for therapeutic interventions.

[1]  B. Wolf,et al.  VEINS OF THE WHITE MATTER OF THE CEREBRAL HEMISPHERES (THE MEDULLARY VEINS). , 1964, The American journal of roentgenology, radium therapy, and nuclear medicine.

[2]  Huang Yp,et al.  VEINS OF THE WHITE MATTER OF THE CEREBRAL HEMISPHERES (THE MEDULLARY VEINS). , 1964 .

[3]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[4]  C. W. Adams,et al.  Perivascular iron deposition and other vascular damage in multiple sclerosis. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[5]  D. Koh,et al.  Statistical evaluation of agreement between two methods for measuring a quantitative variable. , 1989, Computers in biology and medicine.

[6]  O. Wiestler,et al.  Intracranial venous hypertension and the effects of venous outflow obstruction in a rat model of arteriovenous fistula. , 1991, Neurosurgery.

[7]  B. Horwitz,et al.  Method for quantification of brain, ventricular, and subarachnoid CSF volumes from MR images. , 1992, Journal of computer assisted tomography.

[8]  F. Fazekas,et al.  Pathologic correlates of incidental MRI white matter signal hyperintensities , 1993, Neurology.

[9]  J. Haxby,et al.  The effect of white matter hyperintensity volume on brain structure, cognitive performance, and cerebral metabolism of glucose in 51 healthy adults , 1995, Neurology.

[10]  V. Challa,et al.  Periventricular venous collagenosis: association with leukoaraiosis. , 1995, Radiology.

[11]  V Hachinski,et al.  Diffuse vacuolization (spongiosis) and arteriolosclerosis in the frontal white matter occurs in vascular dementia. , 1996, Archives of neurology.

[12]  H. Budka,et al.  Blood-brain barrier dysfunction in Binswanger’s disease; an immunohistochemical study , 1997, Acta Neuropathologica.

[13]  D P Friedman,et al.  Abnormalities of the deep medullary white matter veins: MR imaging findings. , 1997, AJR. American journal of roentgenology.

[14]  S. Halligan.  Statistical evaluation of agreement. , 1999, Radiology.

[15]  K. terBrugge,et al.  Tortuous, engorged pial veins in intracranial dural arteriovenous fistulas: correlations with presentation, location, and MR findings in 122 patients. , 1999, AJNR. American journal of neuroradiology.

[16]  Y. Itoyama,et al.  Silent Cerebral Microbleeds on T2*-Weighted MRI: Correlation with Stroke Subtype, Stroke Recurrence, and Leukoaraiosis , 2002, Stroke.

[17]  Manjit,et al.  Neurology , 1912, NeuroImage.

[18]  M. O’Sullivan,et al.  Patterns of cerebral blood flow reduction in patients with ischemic leukoaraiosis , 2002, Neurology.

[19]  T. Kohriyama,et al.  Frequency of asymptomatic microbleeds on T2*-weighted MR images of patients with recurrent stroke: association with combination of stroke subtypes and leukoaraiosis. , 2004, AJNR. American journal of neuroradiology.

[20]  R. Graf,et al.  Cerebral Venous Infarction: The Pathophysiological Concept , 2004, Cerebrovascular Diseases.

[21]  Wei Wen,et al.  The topography of white matter hyperintensities on brain MRI in healthy 60- to 64-year-old individuals , 2004, NeuroImage.

[22]  R. Shibata,et al.  PARTIAL CORRELATION AND CONDITIONAL CORRELATION AS MEASURES OF CONDITIONAL INDEPENDENCE , 2004 .

[23]  H S Markus,et al.  Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[24]  Niels D Prins,et al.  Cerebral small-vessel disease and decline in information processing speed, executive function and memory. , 2005, Brain : a journal of neurology.

[25]  Markus Barth,et al.  Nonnvasive assessment of vascular architecture and function during modulated blood oxygenation using susceptibility weighted magnetic resonance imaging , 2005, Magnetic resonance in medicine.

[26]  P. Scheltens,et al.  Age, Hypertension, and Lacunar Stroke Are the Major Determinants of the Severity of Age-Related White Matter Changes , 2006, Cerebrovascular Diseases.

[27]  S. Fujii,et al.  White matter changes in elderly people: MR-pathologic correlations. , 2006, Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine.

[28]  Yu-Chung N. Cheng,et al.  Susceptibility weighted imaging (SWI) , 2004, Zeitschrift fur medizinische Physik.

[29]  Bruce M Psaty,et al.  Biomarkers of Inflammation and MRI-Defined Small Vessel Disease of the Brain: The Cardiovascular Health Study , 2008, Stroke.

[30]  Frederik Barkhof,et al.  Progression of White Matter Hyperintensities and Incidence of New Lacunes Over a 3-Year Period: The Leukoaraiosis and Disability Study , 2008, Stroke.

[31]  W. Vandertop,et al.  EXTENSIVE WHITE MATTER CHANGES AFTER STEREOTACTIC RADIOSURGERY FOR BRAIN ARTERIOVENOUS MALFORMATIONS: A PROGNOSTIC SIGN FOR OBLITERATION? , 2008, Neurosurgery.

[32]  P. Scheltens,et al.  Urinary Complaints in Nondisabled Elderly People with Age‐Related White Matter Changes: The Leukoaraiosis And DISability (LADIS) Study , 2008, Journal of the American Geriatrics Society.

[33]  A. Hofman,et al.  Prevalence and risk factors of cerebral microbleeds , 2008, Neurology.

[34]  J. Kril,et al.  Neuropathologic correlates of white matter hyperintensities , 2008, Neurology.

[35]  Steven Warach,et al.  Cerebral Microbleeds : A Field Guide to their Detection and Interpretation , 2012 .

[36]  Yaakov Stern,et al.  Reduction in cerebral blood flow in areas appearing as white matter hyperintensities on magnetic resonance imaging , 2009, Psychiatry Research: Neuroimaging.

[37]  Paolo Zamboni,et al.  Anomalous Venous Blood Flow and Iron Deposition in Multiple Sclerosis , 2009, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[38]  Sandra Black,et al.  Understanding White Matter Disease: Imaging-Pathological Correlations in Vascular Cognitive Impairment , 2009, Stroke.

[39]  H. Markus,et al.  The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis , 2010, BMJ : British Medical Journal.

[40]  Min Lou,et al.  Evaluation of Brain Iron Content Based on Magnetic Resonance Imaging (MRI): Comparison among Phase Value, R2* and Magnitude Signal Intensity , 2012, PloS one.

[41]  Andreas Charidimou,et al.  Cerebral microbleeds: a guide to detection and clinical relevance in different disease settings , 2013, Neuroradiology.