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Research ArticleNEUROVASCULAR/STROKE IMAGING

Decreased Visibility of Deep Medullary Vein Associated with Cerebral Small Vessel Disease Burden through Increased Interstitial Fluid in White Matter

Zhihua Xu, Haiyuan Lan, Xinjun Lei, Hongxia Zhang, Fanfan Xiong and Lebing Wang
American Journal of Neuroradiology May 2025, DOI: https://doi.org/10.3174/ajnr.A8632
Zhihua Xu
aFrom the Department of Radiology (Z.X., H.Z., F.X.), Tongde Hospital of Zhejiang Province, Hangzhou, China
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  • ORCID record for Zhihua Xu
Haiyuan Lan
bDepartment of Radiology (H.L., X.L., L.W.), Lishui Hospital of Traditional Chinese Medicine, affiliated with Zhejiang Chinese Medical University, Lishui, China.
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Xinjun Lei
bDepartment of Radiology (H.L., X.L., L.W.), Lishui Hospital of Traditional Chinese Medicine, affiliated with Zhejiang Chinese Medical University, Lishui, China.
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Hongxia Zhang
aFrom the Department of Radiology (Z.X., H.Z., F.X.), Tongde Hospital of Zhejiang Province, Hangzhou, China
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Fanfan Xiong
aFrom the Department of Radiology (Z.X., H.Z., F.X.), Tongde Hospital of Zhejiang Province, Hangzhou, China
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Lebing Wang
bDepartment of Radiology (H.L., X.L., L.W.), Lishui Hospital of Traditional Chinese Medicine, affiliated with Zhejiang Chinese Medical University, Lishui, China.
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Abstract

BACKGROUND AND PURPOSE: Decreased visibility of deep medullary veins (DMVs) on susceptibility-weighted imaging (SWI) has been reported in individuals with cerebral small vessel disease (CSVD). This study aims to explore the relationship between the decreased visibility of the DMV, interstitial fluid (ISF), and the CSVD burden.

MATERIALS AND METHODS: Patients with CSVD (n = 128) were enrolled with multimode MRI. The DMV score was used to score visibility of DMVs on SWI. ISF was evaluated by mean free water (FW) on diffusion tensor imaging in white matter. CSVD burden was evaluated, including the severity of each CSVD marker at MRI and total CSVD MR score.

RESULTS: The DMV score was associated with the severity of each CSVD imaging marker and total CSVD MR score (P < .05). Further, the indirect effect of the DMV score on the severity of CSVD imaging makers [white matter hyperintensity (WMH), cerebral microbleed (CMB) and lacunar infarct (LI)] and total CSVD MR score mediated by FW was significant [WMH: β, 95% CI: 0.13 (0.05, 0.24); LI: β, 95% CI: 0.19 (0.06, 0.32); CMB: β, 95% CI: 0.13 (0.01, 0.30); total CSVD MR score: β, 95% CI: 0.16 (0.05, 0.29)] controlling with age and vascular risk factors.

CONCLUSIONS: The DMV score was associated with the CSVD burden through FW in white matter in individuals with CSVD and may describe a venous aspect of the pathogenesis of the CSVD burden.

ABBREVIATIONS:

CMB
cerebral microbleed
CSVD
cerebral small vessel disease
DMV
deep medullary vein
FW
free water
HPVS
high-grade perivascular space
HWMH
high-grade white matter hyperintensity
IQR
interquartile range
ISF
interstitial fluid
LI
lacunar infarct
PVS
perivascular spaces
WMH
white matter hyperintensity

Footnotes

  • This study was supported by grant 2022KY707 and 2024KY866 from the Medical and Health Science and Technology Program of Zhejiang Provincial Health Commission of China, grant 2024ZR048 from Zhejiang Province Traditional Chinese Medicine Science and Technology Project.

  • Disclosure forms provided by the authors are available with the full text and PDF of this article at www.ajnr.org.

  • © 2025 by American Journal of Neuroradiology
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Cite this article
Zhihua Xu, Haiyuan Lan, Xinjun Lei, Hongxia Zhang, Fanfan Xiong, Lebing Wang
Decreased Visibility of Deep Medullary Vein Associated with Cerebral Small Vessel Disease Burden through Increased Interstitial Fluid in White Matter
American Journal of Neuroradiology May 2025, DOI: 10.3174/ajnr.A8632

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DMV, IFS and CSVD burden
Zhihua Xu, Haiyuan Lan, Xinjun Lei, Hongxia Zhang, Fanfan Xiong, Lebing Wang
American Journal of Neuroradiology May 2025, DOI: 10.3174/ajnr.A8632
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