Note that the convergence point is at the lateral wall of the lateral ventricle. The tigroid and leopard-skin patterns of demyelination, which suggest sparing of the perivascular white matter, can be seen in the periventricular white matter and centrum semiovale (54). Deep medullary vein engorgement. They analyzed angiographic findings and designated them as MVMs because the most characteristic part of the malformation is medullary veins. The demonstration of prominent medullary veins in the deep white matter ipsilateral to acute ischemic stroke has been shown to predict poor clinical outcome. (Reprinted, with permission, from reference 48.). On the other hand, imaging studies of white matter have lagged behind studies of gray matter because identification of white matter tracts at computed tomography (CT) or conventional magnetic resonance (MR) imaging is difficult. Axial SWI(d) shows a convergent-type hemorrhage (arrows) in the right frontal lobe. Superficial Draining Veins.—The parenchymal veins of the cerebral hemisphere are divided into those that drain superficially, those that drain deeply, and the transcerebral vein (8–10). One of the characteristic distribution patterns of MS plaques involves subcortical or juxtacortical U-fiber lesions. (d–f) DVI in a 17-year-old girl, 10 days after injury in a traffic accident. Axial SWI(g) shows a convergent-type hemorrhage (arrows) in the left and right frontal lobes. Transverse scan through the upper abdominal aorta showed no colour Doppler signal within the … The most likely explanation is that medullary veins are compressed by growing nerve fiber tracts (7). Axial T2-weighted images show symmetric diffuse white matter hyperintensities. 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. It may be difficult to make a correct diagnosis in cases without pathological examination. In an MR imaging study of the lesion patterns in neonates with congestion and/or thrombosis of the deep medullary veins in association with a pathologic chain of events in preterm and full-term neonatal encephalopathy, radial linear lesions in the white matter territory with distribution of deep medullary veins were observed (31). (a) Contrast-enhanced image from SWI. PURPOSE The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) can be dichotomized into prominent cortical veins (PCV) and prominent medullary veins (PMV). ), Figure 11b. The correlations between prominent vein grades with different imaging and clinical variables were determined. Therefore, it is essential to focus on prominent deep medullary veins that can be reliably detected. Axial T2-weighted image (h) shows high signal intensity (arrows) in the corresponding areas in the left and right frontal lobes, which seems to represent edema. DVI due to traumatic brain injury. Deep medullary veins drain into subependymal veins with four convergence zones and show parallel distribution patterns adjacent to the body or inferior horn and a radial pattern in the frontal horn or trigon of the lateral ventricle. (d–f)MS in a 34-year-old woman. The area of the convergent-type hemorrhage is not identical to that of the DAI and is larger than it. (a–c) A 10-day-old infant girl with bacterial ventriculitis. (c) At SWI, fan-shaped multiple low-intensity signals can be seen in the bilateral frontal and parietal white matter, suggesting microhemorrhages due to congestion of the medullary veins. The prominent vessel sign score was 0 (10–7–3 = 0). Changes in Oxygenation Visualized in Medullary Veins atSWI.—The hemodynamic effect of an occlusive or stenotic lesion can be categorized into three stages: stage 0, normal cerebral hemodynamics; stage 1, autoregulatory vasodilatation; and stage 2, increased oxygen extraction. Open in Image (b)DWI shows high-signal-intensity cortical signals only in the temporooccipital region. Sturge-Weber syndrome in an 18-year-old man with a hemifacial angioma on the right side. This pattern is observed in several other diseases, including globoid cell leukodystrophy (55), Alexander disease (57), Lowe syndrome (58), and lissencephaly with cerebellar hypoplasia (59). Figure 5h. Figure 6b. Histologically, in perivenular regions, which correspond to the stripes at MR imaging, myelin is relatively more prominent in metachromatic leukodystrophy. A mean 64.5% decrease and a 52.4% increase of differences in hemispheric CBF were found in ipsilateral medullary veins and contralateral medullary veins, respectively. Pathologic analysis at biopsy demonstrated lymphoid proliferation. Xu Z, Duan Y, Yang B, Huang X, Pei Y, Li X. However, due to obstruction or hypotrophy in the connection between the longitudinal caudate vein and the subependymal vein (SEV), the flow of drainage reverses its direction and drains into the cerebral surface via an extremely enlarged transcerebral vein (TCV), and finally drains into the superior sagittal sinus (SSS). It is well known that prominent medullary veins and early filling deep cerebral veins are seen on angiograms in cases of malignant astrocytoma or glioblastoma multi- forme, even when mass effect is absent [10]. (d–f) LYG in a 22-year-old woman after chemotherapy for osteosarcoma. Axial DSA(c) shows enlarged medullary veins (arrows). When lesions show a parallel or radial distribution pattern in the certebral deep white matter, disorders related to deep medullary veins should be considered for differential diagnosis. The deep medullary veins converge three times in the course from the subcortical region to the subependymal layer. Venous angioarchitecture in the cerebrum. Contrast-enhanced MR image (b) shows fan-shaped enhancement (dotted area) that converges in the wall of the lateral ventricle, indicating perivenous spread of inflammation. At SWI(a), a convergent-type hemorrhage (arrows) can be seen in the right occipital lobe. Often not continuous, although it is continuous in the frontotemporal operculum a 17-year-old girl, 10 days injury! Infants, germinal matrix hemorrhages are the most likely explanation is that medullary on. Used to calculate differences in hemispheric CBF from corresponding areas affected in full-term.. 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