prominent medullary veins radiology

The multiple hemorrhages are speculated to be related to the distribution of medullary veins. Axial SWI(g) shows a convergent-type hemorrhage (arrows) in the left and right frontal lobes. (a–c) LYG in a 68-year-old woman. The deep drainage type might be caused by an obstruction at a connecting segment between central deep medullary veins and corresponding subependymal veins, resulting in drainage of other subependymal veins via detour course (13,15) (Fig 3d–3f). Susceptibility-weighted imaging (C, D) at the basal ganglion and suprabasal ganglion levels reveals prominent vessel signs in the cortical veins (arrows), medullary veins (arrows) and thalamostriate vein (arrowhead). Clipboard, Search History, and several other advanced features are temporarily unavailable. 4 Mildly prominent DMVs Many dark, distinct deep medullary veins are visible, either diffusely or regionally. At SWI(d) and contrast-enhanced MR imaging (e), there are dilatations of the deep-draining medullary vein in the occipitotemporal white matter. (a–c) DVI in a 61-year old man, 8 days after injury in a traffic accident. (Reprinted, with permission, from reference 8.) Histopathologically, in Pelizaeus-Merzbacher disease, the foci are residual islets of preserved myelin around blood vessels (60). Figure 3e. (b) However, DWI does not show a high-intensity signal. The ipsilateral medullary vein was independently associated with poor outcome (odds ratio, 11.19; P = .046). Figure 4c. As shown on a schematic drawing (c), the dilated veins run toward the superolateral edge of the lateral ventricle via the second (candelabra) zone of convergence (arrow in a and b) and third (palmate) zone of convergence and converge into several longitudinal caudate veins of Schlesinger (LC) (arrowhead in a and b). While the areas at axial DWI (i) show high signal intensity (arrows), an axial ADC image (j) shows high signal intensity (arrows) in the corresponding areas, which indicates increased diffusivity in the areas and thus vascular edema. (g–j) DVI in a 16-year-old boy, 5 days after injury in a traffic accident. The transcerebral veins are also called medullary or anastomotic veins, as they interconnect the superficial with the deep venous systems. Axial DSA(c) shows enlarged medullary veins (arrows). In both cases, radial or fan-shaped hemorrhages can be seen on axial T2-weighted (b, e) and T2*-weighted (c, f) images, representing hemorrhages related to medullary veins. At contrast medium–enhanced CT or MR imaging, dilated medullary veins that converge into a single stem vein and terminate in a cortical or subependymal vein are visualized. The prominent vessel sign score was 0 (10–7–3 = 0). 6, © 2021 Radiological Society of North America, Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging, Visualizing non-Gaussian diffusion: clinical application of q-space imaging and diffusional kurtosis imaging of the brain and spine, Recherches anatomiques sur la circulation de l’encéphale, Concepts of cerebral venous drainage and the aetiology of hydrocephalus, The venous drainage of the brain, with special reference to the Galenic system, Veins of the white matter of the cerebral hemispheres (the medullary veins), Micro-angiographical studies of the medullary venous system of the cerebral hemisphere, Development of posterior fossa dural sinuses, emissary veins, and jugular bulb: morphological and radiologic study, Venous architecture of cerebral hemispheric white matter and comments on pathogenesis of medullary venous and other cerebral vascular malformations, Normal anatomy of intracranial veins: demonstration with MR angiography, 3D-CT angiography and microangiographic injection study, The pathology of tumors of the nervous system, Pathology of tumors of the nervous system, Cerebral venous malformations and new classification of cerebral vascular malformations, Developmental venous anomalies (DVA): the so-called venous angioma, MR evaluation of developmental venous anomalies: medullary venous anatomy of venous angiomas, Diffusion and perfusion MRI findings of the signal-intensity abnormalities of brain associated with developmental venous anomaly, MR and MR angiography of Sturge-Weber syndrome, Evolution of a symptomatic diffuse developmental venous anomaly with progressive cerebral atrophy in an atypical case of Sturge-Weber syndrome, Imaging assessment of traumatic brain injury, Diffuse vascular injury in fatal road traffic accident victims: its relationship to diffuse axonal injury, Neuropathological investigation of cerebral white matter lesions caused by closed head injury, Clinical review: Prognostic value of magnetic resonance imaging in acute brain injury and coma, MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions, Diffuse vascular injury: convergent-type hemorrhage in the supratentorial white matter on susceptibility-weighted image in cases of severe traumatic brain damage, Cerebrovascular injury in premature infants: current understanding and challenges for future prevention, Vascular architecture in white matter of neonates: its relationship to periventricular leukomalacia, Deep medullary vein involvement in neonates with brain damage: an MR imaging study, Pathology, histochemistry and immunocytochemistry of lesions in acute multiple sclerosis, Demonstrating the perivascular distribution of MS lesions in vivo with 7-Tesla MRI. The mechanism of formation of convergence zones is not clear. (d–f)MS in a 34-year-old woman. Xu Z(1)(2), Duan Y(2), Yang B(3), Huang X(4), Pei Y(3), Li X(5). Susceptibility weighted imaging in cerebral hypoperfusion: can we predict increased oxygen extraction fraction? (Courtesy of Ryuta Itoh, MD, PhD, Shiga University of Medical Science Hospital.) On DSA, appear as tiny, relatively uniform, contrast-filled, linear structures that terminate at right angles to ventricular subependymal veins. (a–c)MS in a 30-year-old man who complained of right hemianopsia. (b) On a FLAIR image, cortical thickening and high signal intensity in the cortex and the subcortical region, as well as hypertrophy (arrowhead) of the choroid plexus, can be seen. (d–f)MS in a 34-year-old woman. This site needs JavaScript to work properly. In 1874, Duret (3) published his investigation of the anatomy of the cerebral vessels. Thus. Note the four convergence points. From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N. Most white matter lesions in MS show a perivascular (perivenous) distribution. At SWI(a), a convergent-type hemorrhage (arrows) can be seen in the right occipital lobe. Miki et al (35) reported the frequency and location of isolated U-fiber involvement in MS, with isolated U-fiber lesions being detected in 53% of cases. Notice the prominent vein of Trolard (red arrow) and vein of Labbe (blue arrow). Pathologic analysis at biopsy demonstrated lymphoid proliferation. (Courtesy of Ryuta Itoh, MD, PhD, Shiga University of Medical Science Hospital.) (a–c) Medullary venous malformation (superficial type) in a 62-year-old man. Primary malformation in development of vein of Galen -AV shunts involving embryologic venous precursors (median vein of prosencephalon) -Choroidal arteriovenous fistula with no nidus -Absence of normal vein of Galen -Median vein of prosencephalon does not drain normal brain tissue -Manifests as high-output congestive heart failure (CHF) in infants and hydrocephalus in older children MPR CT with prominent subclavian artery and vein draining extensive limb AVF Radiology Department // Mediclinic Airport. On T1-weighted images (a, d), it appears that the patient with the coagulation disorder has more serious parenchymal hemorrhages. The typical locations of DAI lesions are the gray-white matter junctions, the corpus callosum and the deep white matter, the periventricular and hippocampal regions, and the brainstem (20). DVI due to traumatic brain injury. Two cases in which LYG is suspected and contrast enhancement with characteristic distribution is visualized are presented in Figure 10. (Reprinted, with permission, from reference 26.) Figure 3d. Epub 2017 Mar 16. Intravascular Lymphomatosis.—Intravascular lymphomatosis (IVL) is a disease involving intraluminal proliferation of non-Hodgkin lymphoma cells in blood vessels, resulting in occlusion of arterioles, capillaries, and venules throughout the body by malignant lymphomatous cells. This study was designed to compare the predictive value of PCV and PMV in the evaluation of the severity of acute ischemic stroke (AIS) in patients within the reperfusion window. Note that the convergence point is at the lateral wall of the lateral ventricle. Figure 10f. There are defects or hypotrophy of the cortical veins or superficial draining veins in the area with dilated deep medullary veins. Figure 2b. The terminology of the cerebral venous structures is still not completely established, and thus, several variations in terminology are used. The supratentorial deep medullary veins converge on the lateral ventricle in a wedge-shaped or fanlike pattern and typically cluster near the subependymal vein at the lateral corner of the lateral ventricle. (a–c) Medullary venous malformation (superficial type) in a 62-year-old man. Figure 5f. Note that the convergence point is at the lateral wall of the lateral ventricle. • Medullary veins. In the deep drainage type, numerous dilated fine deep medullary veins in the subcortical region run deeply, converging into dilated central medullary veins in the cerebral white matter, and drain into the deep venous system through an unusual course, the remote anastomosis between the longitudinal caudate veins of Schlesinger and subependymal veins, because of the defects or blockages in the original draining course between the longitudinal caudate veins and subependymal veins. Case of trigeminal neuralgia due to venous compression by the lateral pontine vein — courtesy of Dr. Eytan Raz. Axial T2*-weighted images (h, i) show dilatation of the medullary vein. LYG shows a polymorphic lymphoid infiltrate along perivascular spaces. It is described prominent contrast enhancement flow voids associated to enlargement of the cavernous sinus (es) and reflux to the superior ophthalmic vein. Deep Draining Veins.—Medullary veins are the parenchymal veins that lie within the white matter of the cerebral hemispheres. However, when the morphology of the vessel structure and white matter fiber tract is compared and correlated, some hypotheses emerge. (a–c) A 10-day-old infant girl with bacterial ventriculitis. Understanding of the medullary veins using modern neuroradiologic approaches began after development of angiographic equipment and techniques. (b) On a FLAIR image, cortical thickening and high signal intensity in the cortex and the subcortical region, as well as hypertrophy (arrowhead) of the choroid plexus, can be seen. In this pattern, the deep medullary veins become part of the lateral or medial group of subependymal veins. AHLE in a 49-year-old woman. Developmental venous anomaly (DVA) is a common vascular malformation with an estimated incidence of 2.5% ().It is referred to as “caput medusae” because of multiple fine veins draining into a single collecting vein of unusual location and size ().While imaging and clinical findings suggest DVAs to be an embryologic variant of venous drainage, its clinical significance remains controversial (). Perinatal venous … Subsequent studies have shown an association between prominent medullary veins and poor clinical outcome. Therefore, it is essential to focus on prominent deep medullary veins that can be reliably detected. In this article, we use the terminology of Okudera et al (7) as shown in the Table. At angiography or digital subtraction angiography (DSA), MVMs appear as medusalike, mushroom-shaped, or umbrella-shaped lesions. 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