In order to identify the zones of convergence of the medullary veins of the cerebral white matter, gelatin-mixed barium sulfate was injected into normal brains at autopsy. A catheter was inserted into the internal jugular veins or the carotid and vertebral arteries. Serial soft tissue roentgenograms of whole brains and brain slices were used to determine the zones of convergence. The deep med-ullary veins had four zones of covergence before draining into the subependymal veins: the first (superficial), second (candelabra), third (palmate) and fourth (subependymal). The zones of various convergence within the white matter were due to the crossing of nerve fiber tracts (e.g. the pes of the corona radiata, the radiation of the corpus callosum, the superior occipitofrontal fasciculus, the tapetum and the sagittal strata). Similar but less conspicuous information about the parenchymal arteries was observed in the arterial injection studies. These results suggest that micro-angiographical studies of the medullary veins of the cerebral white matter provide detailed information on veno-architecture and convergence zones. This information may help in understanding the pathogenesis of medullary venous malformations.

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. As white matter imaging develops such as diffusion tensor imaging or susceptibility-weighted imaging, requirements for understanding of white matter structures are increasing, not only for understanding of neuronal tracts but also for that of other structures including the fine anatomy of white matter vessels. Some disorders are related to deep medullary veins and show characteristic distributions of the lesions indicating the relationship to the medullary veins. 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. In this review, we discuss disorders related to deep medullary veins, including (a) anomalies of the medullary veins, (b) hemorrhagic disorders related to the medullary veins (diffuse vascular injury due to high-energy trauma, deep medullary vein engorgement/thrombosis in neonates), (c) inflammatory changes that spread along the medullary veins, (d) neoplasms within the medullary veins, and (e) metabolic changes that lead to altered visualization of medullary veins. Understanding the anatomic structure of medullary veins in the cerebral hemisphere and becoming familiar with disorders in which the medullary veins play a major role in disease development may be helpful in the interpretation of brain images. RSNA, 2017.

There were a positive correlation between calcium scores on CT and angiographic changes of arteriosclerosis in the siphon as well as bifurcation, indicating angiographic changes can be predicted using calcium scores. However, the degree of calcification in the siphon cannot be used to predict the possibility of a future cerebral stroke.

For follow-up after coiling with an Enterprise stent, CE-MRA may be necessary to avoid susceptibility artifacts caused by the stent.

Vulnerable carotid plaques have a significantly higher risk of slow-flow phenomenon than stable plaques. The occurrence of the slow-flow phenomenon can be predicted by MR plaque imaging before CAS.