Deep Medullary Vein Involvement in Neonates with Brain Damage: An MR Imaging Study

Abstract

BACKGROUND AND PURPOSE: Different and specific MR imaging patterns of lesions involving WM are widely defined in neonatal encephalopathy. The aim of this study was to describe a novel MR imaging pattern of damage characterized by the abnormal prominence of DMVs in premature and full-term neonates.

Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants

“…The abrupt fluctuation in cerebral blood flow caused by rescue therapy may worsen IVH and cPVL via ischemia-reperfusion injury, which is detrimental to very preterm infants during the peak period of white matter injury [1,22,23]. High-grade IVH may further accentuate the development of cPVL by tissue compression from ventricular dilatation, release of inflammatory proteins through the disrupted ependymal barrier, or congestion/thrombosis of deep medullary veins [9,24]. …”

Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging

“…Appreciation of the medullary veins via US is not a new finding, as it was described in neonates as far back as 1990 by Hertzberg et al 73 There are several types of draining veins in fetuses and neonates, including superficial medullary veins, deep medullary veins, and transcerebral veins. 74 However, clinical interest primarily surrounds the deep medullary veins, which extend in a reverse fan-shaped pattern from the white matter toward the ventricles and drain into subependymal veins above the caudate nucleus or at the roof of the occipital horns. 74 On occasion, normal medullary veins may be observed when there are no abnormal findings on fetal MRI, fetal US, or head US examinations of premature infants.…”

Visualizing cerebral veins in fetal brain using susceptibility-weighted MRI

“…A medical history was collected for each participant, especially regarding risk factors for the foetus. The criteria for participant enrolment were as follows: (1) all participants were in a stable clinical condition with no known contraindications to MRI; (2) no participant had diagnosed or self-reported malignancy, cardiovascular disease, pulmonary disease, metabolic disease, renal disease, hepatic disease, parathyroid gland diseases, rheumatoid arthritis, malabsorption syndrome, blood diseases, as well as coexisting diabetes; and (3) none of the participants were using therapies that affect foetal development (such as glucocorticoids, immunosuppressive medications). Institutional review board approval was obtained prior to the MRI examinations, and written informed consent was obtained for all participants.…”

“…So far, T1-, T2-weighted turbo spin echo (TSE) sequences, and T2*-weighted echo planar imaging (EPI) sequence have been used to demonstrate diseases related to foetal veins in a few studies. 1,2 Susceptibility-weighted imaging (SWI) is well known as a three-dimensional (3D) gradient-echo sequence (GRE) based technique. With phase information as an additional source of contrast, SWI is able to visualize the susceptibility changes induced by different substances, such as blood products (haemosiderin and ferritin), deoxygenated blood, iron, and calcium, and small vein depiction in various physiological and pathological conditions.…”

“…1,2 For instance, perinatal stroke is a common cerebrovascular disorder affecting one in every 4000 births, which accounts for 30% of children with hemiplegic cerebral palsy (CP). 3,4 Perinatal ischaemic stroke has been defined as a group of heterogeneous conditions in which there is a focal disruption of cerebral blood flow secondary to arterial or cerebral venous thrombosis or embolization, between the 20 th weeks of foetal life through the 28 th post-natal day, and confirmed by neuroimaging or neuropathological studies.…”