Cerebral Venous Reflux and Cerebral Amyloid Angiopathy: An Magnetic Resonance Imaging/Positron Emission Tomography Study

Abstract

Background: Cerebral venous outflow alterations contribute to central nervous system pathology in aging and neurodegenerative disorders and are potentially linked to underlying cerebral microangiopathy. We investigated whether cerebral venous reflux (CVR) is more closely associated with cerebral amyloid angiopathy (CAA) than hypertensive microangiopathy in intracerebral hemorrhage (ICH) survivors. Methods: This cross-sectional study included 122 patients of spontaneous ICH with magnetic resonance and positron emission tomography imaging studies (2014–2022) in Taiwan. The presence of CVR was defined as abnormal signal intensity in the dural venous sinus or internal jugular vein on magnetic resonance angiography. Cerebral amyloid load was measured using the Pittsburgh compound B standardized uptake value ratio. Clinical and imaging characteristics associated with CVR were evaluated in univariable and multivariable analyses. In the subset of patients with CAA, we applied univariable and multivariable linear regression analyses to evaluate the association between CVR and cerebral amyloid retention. Results: Compared with patients without CVR (n=84, 64.5±12.1 years), patients with CVR (n=38, 69.4±11.5 years) were significantly more likely to have CAA-ICH (53.7% versus 19.8%; P< 0.001) and had a higher cerebral amyloid load (standardized uptake value ratio [interquartile range], 1.28 [1.12–1.60] versus 1.06 [1.00–1.14]; P< 0.001). In a multivariable model, CVR was independently associated with CAA-ICH (odds ratio, 4.81 [95% CI, 1.74–13.27]; P= 0.002) after adjustment for age, sex and conventional small vessel disease markers. In CAA-ICH, higher PiB retention was observed in patients with CVR than patients without CVR (standardized uptake value ratio [interquartile range], 1.34 [1.08–1.56] versus 1.09 [1.01–1.26]; P <0.001). In multivariable analysis after adjustment for potential confounders, the presence of CVR was independently associated with a higher amyloid load (standardized β=0.40; P =0.001). Conclusions: In spontaneous ICH, CVR is associated with CAA and a higher amyloid burden. Our results suggest venous drainage dysfunction potentially plays a role in CAA and cerebral amyloid deposition.

VICTR: Venous transit time imaging by changes in T1 relaxation

“…It represents the primary channel for draining deoxygenated blood and waste products, maintaining intracranial pressure, and regulating CSF circulation 1,2 . The cerebral venous system is susceptible to pathological alterations, and many neurological disorders such as intracranial hypertension, 3 venous malformation, 4 stroke, 5,6 ventriculomegaly, 7 cerebral small vessel disease, 8,9 multiple sclerosis, 10 and cerebral amyloid angiopathy 11 specifically involve abnormalities in venous anatomy and hemodynamic function.…”

Impaired Venous Outflow and Lacunar Stroke Outcomes: A Pilot Study

“…The primary exposure was the presence of IVO, defined by prior studies as lateralized hyperintensity along the intracranial internal jugular vein or the sigmoid, transverse, or petrosal sinuses on magnetic resonance angiography time-of-flight and without competing causation (Figure). 1,3 The primary outcome was functional disability by modified Rankin Scale. χ 2 , Student t test, and binary logistic regression were used as appropriate, with the latter adjusted for significant ( P <0.05) confounders.…”

“…Overall, 9 lacunar strokes occurred in the basal ganglia, While typically overlooked, venous pathology, either in the form of localized venule collagen deposition or IVO of the draining veins, has importance in a variety of conditions, such as normal pressure hydrocephalus and neurodegenerative conditions. 2,3,5 From a cerebral small vessel disease perspective, IVO is associated with higher burdens of leukoariosis and enlarged perivascular spaces. 1,4 Larger cohorts with dedicated cardiac and cervicocranial venous imaging are needed to confirm or refute these findings and surmise the pathogenic mechanisms.…”