Neurologic/Head and Neck Imaging

Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders

Published Online:https://doi.org/10.1148/rg.2017160061

Understanding the anatomic structure of medullary veins in the cerebral hemisphere may be helpful in the interpretation of brain images of disorders in which the medullary veins play a major role in disease development.

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

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Article History

Received: Mar 28 2016
Revision requested: June 7 2016
Revision received: June 27 2016
Accepted: July 13 2016
Published online: Jan 11 2017
Published in print: Jan 2017