Deep medullary vein engorgement and superficial medullary vein engorgement: two patterns of perinatal venous stroke

Khalatbari, Hedieh; Wright, Jason N.; Ishak, Gisele E.; Perez, Francisco A.; Amlie‐Lefond, Catherine; Shaw, Dennis

doi:10.1007/s00247-020-04846-3

Cited by 19 publications

(26 citation statements)

References 60 publications

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“…SWI was used to determine the difference in magnetic sensitivity between the different tissues to form an image comparison and a thin-layer reconstructed gradient-echo imaging sequence with the three-dimensional acquisition, completed flow compensation signal, and high signal-to-noise ratio. Due to their smaller size on SWI, DMVs are better seen when there is increased intravenous deoxyhemoglobin, venous congestion, or thrombosis, but not in the MR venography sequences in neonates ( Khalatbari et al, 2020 ). Compared with conventional MRI sequences, SWI is superior in delineating cerebral venous structures in both healthy subjects and patients with HIE.…”

Section: Discussionmentioning

confidence: 99%

“…There are relatively few studies on neonatal DMVs. DMV engorgement seen in neonates is thought to be a type of perinatal venous stroke ( Khalatbari et al, 2020 ). Severe WM injury in preterm infants may be caused by DMV congestion or thrombosis, which can later develop into periventricular leukomalacia ( Chen et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral hypoxia and ischemia can lead to cerebral venous congestion and increased venous pressure, which in turn, can easily cause the deep cerebral and cortical veins to expand to varying degrees ( Mukherjee et al, 2021 ). Neonates with hypoxic-ischemic brain injury and HIE have recently been reported to have abnormal, prominent veins ( Messina et al, 2013 ), and there is a close relationship between the deep medullary veins (DMV) and WM injury in neonates ( Arrigoni et al, 2011 ; Chen et al, 2020 ; Khalatbari et al, 2020 ; Benninger et al, 2021 ). In some infants, the veins are indeed prominent.…”

Section: Introductionmentioning

confidence: 99%

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A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging

Zhuang

Jin

et al. 2023

Front. Neurosci.

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ObjectiveThe deep medullary veins (DMVs) can be evaluated using susceptibility-weighted imaging (SWI). This study aimed to apply radiomic analysis of the DMVs to evaluate brain injury in neonatal patients with hypoxic-ischemic encephalopathy (HIE) using SWI.MethodsThis study included brain magnetic resonance imaging of 190 infants with HIE and 89 controls. All neonates were born at full-term (37+ weeks gestation). To include the DMVs in the regions of interest, manual drawings were performed. A Rad-score was constructed using least absolute shrinkage and selection operator (LASSO) regression to identify the optimal radiomic features. Nomograms were constructed by combining the Rad-score with a clinically independent factor. Receiver operating characteristic curve analysis was applied to evaluate the performance of the different models. Clinical utility was evaluated using a decision curve analysis.ResultsThe combined nomogram model incorporating the Rad-score and clinical independent predictors, was better in predicting HIE (in the training cohort, the area under the curve was 0.97, and in the validation cohort, it was 0.95) and the neurologic outcomes after hypoxic-ischemic (in the training cohort, the area under the curve was 0.91, and in the validation cohort, it was 0.88).ConclusionBased on radiomic signatures and clinical indicators, we developed a combined nomogram model for evaluating neonatal brain injury associated with perinatal asphyxia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging

Zhuang

Jin

et al. 2023

Front. Neurosci.

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“…Neuroimaging studies of term and preterm infants have shown that transient deep medullary vein engorgement or thrombosis may lead to white matter lesions in a periventricular distribution while superficial medullary vein engorgement is associated with subpial hemorrhage. 18,19,42 In our sample of preterm infants, there was only one participant with definitive medullary vein thrombosis and accompanying periventricular white matter lesions. There may have been more preterm infants with white matter lesions secondary to medullary vein congestion or transient medullary vein thrombosis that had resolved at the time of imaging.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Venous Sinus Thrombosis in Preterm Infants

Christensen

Krishnan

deVeber

et al. 2022

Stroke

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BACKGROUND: Neonatal cerebral venous sinus thrombosis (CVST) can lead to brain injury and neurodevelopmental impairments. Previous studies of neonatal CVST have focused on term infants, and studies of preterm infants are lacking. In this study, we examined the clinical and radiological features, treatment and outcome of CVST in preterm infants. METHODS: This was a retrospective, consecutive cohort study of preterm infants (gestational age <37 weeks) with radiologically confirmed CVST. All magnetic resonance imaging/MRV and CT/CTV scans were re-reviewed to study thrombus characteristics and pattern of brain injury. Outcome was assessed by the validated pediatric stroke outcome measure at the most recent clinic visit. RESULTS: Twenty-six preterm infants with CVST were studied. Of these, 65% were moderate-late preterm (32–37 weeks), 27% very preterm (28–32 weeks), and 8% extreme preterm (<28 weeks). Most (73%) were symptomatic at presentation with seizures or abnormal exam. Transverse (85%) and superior sagittal (42%) sinuses were common sites of thrombosis. Parenchymal brain injury was predominantly periventricular (35%) and deep white matter (31%) in location. Intraventricular hemorrhage occurred in 46%. Most infants (69%) were treated with anticoagulation. No treated infant (including eleven with pretreatment hemorrhage) had new or worsening post-treatment hemorrhage. Outcomes ranged from no deficits (50%), mild-moderate (25%), and severe (25%) impairment. CONCLUSIONS: In our sample of preterm infants with CVST, more than one-quarter were asymptomatic. White matter brain lesions predominated and one-half had neurological deficits at follow-up. Anticoagulation of preterm CVST in this small cohort appeared to be safe. Larger studies of preterm CVST are needed.

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“…In some cases, these vessels may also penetrate the sub-cortical WM. In this superficial brain region, drainage occurs centrifugally (away from the center) as associated veins carry blood back to the pial surface and eventually the superior sagittal sinus via the intra-cortical, subcortical, and superficial medullary veins 8,9 . In deeper WM regions, blood is drained centripetally.…”

Section: Introductionmentioning

confidence: 99%

Medullary vein architecture modulates the white matter BOLD cerebrovascular reactivity signal response to CO₂: observations from high-resolution T2^*weighted imaging at 7T

Bhogal

2021

Preprint

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Brain stress testing using blood oxygenation level-dependent (BOLD) MRI to evaluate changes in cerebrovascular reactivity (CVR) is of growing interest for evaluating white matter integrity. However, even under healthy conditions, the white matter BOLD-CVR response differs notably from that observed in the gray matter. In addition to actual arterial vascular control, the venous draining topology may influence the WM-CVR response leading to signal delays and dispersions. These types of alterations in hemodynamic parameters are sometimes linked with pathology, but may also arise from differences in normal venous architecture. In this work, high-resolution T2*-weighted anatomical images combined with BOLD imaging during a hypercapnic breathing protocol were acquired using a 7 tesla MRI system. Hemodynamic parameters including base CVR, hemodynamic lag, lag-corrected CVR, response onset and signal dispersion, and finally delta-CVR (corrected CVR minus base CVR) were calculated in 8 subjects. Parameter maps were spatially normalized and correlated against an MNI-registered white matter medullary vein atlas. Moderate correlations (Pearsons rho) were observed between medullary vessel frequency (MVF) and delta-CVR (0.52; 0.58 for total WM), MVF and hemodynamic lag (0.42; 0.54 for total WM), MVF and signal dispersion (0.44; 0.53 for total WM), and finally MVF and signal onset (0.43; 0.52 for total WM). Results indicate that, when assessed in the context of the WM venous architecture, changes in the response shape may only be partially reflective of the actual vascular reactivity response occurring further upstream by control vessels. This finding may have implications when attributing diseases mechanisms and/or progression to presumed impaired WM BOLD-CVR.

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Deep medullary vein engorgement and superficial medullary vein engorgement: two patterns of perinatal venous stroke

Cited by 19 publications

References 60 publications

A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging

A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging

Cerebral Venous Sinus Thrombosis in Preterm Infants

Medullary vein architecture modulates the white matter BOLD cerebrovascular reactivity signal response to CO₂: observations from high-resolution T2^*weighted imaging at 7T

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Deep medullary vein engorgement and superficial medullary vein engorgement: two patterns of perinatal venous stroke

Cited by 19 publications

References 60 publications

A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging

A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging

Cerebral Venous Sinus Thrombosis in Preterm Infants

Medullary vein architecture modulates the white matter BOLD cerebrovascular reactivity signal response to CO2: observations from high-resolution T2*weighted imaging at 7T

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Medullary vein architecture modulates the white matter BOLD cerebrovascular reactivity signal response to CO₂: observations from high-resolution T2^*weighted imaging at 7T