Jeong Jeong-Won, Lee Min-Hee, Luat Aimee F, Xuan Yang, Haacke E Mark, Juhász Csaba
Department of Pediatrics, Wayne State University School of Medicine, University Health Center, Detroit, MI, USA.
Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.
Quant Imaging Med Surg. 2024 Feb 1;14(2):1916-1929. doi: 10.21037/qims-23-1271. Epub 2024 Jan 23.
Enlarged deep medullary veins (EDMVs) in patients with Sturge-Weber syndrome (SWS) may channel venous blood from the surface to the deep vein system in brain regions affected by the leptomeningeal venous malformation. Thus, the quantification of EDMV volume may provide an objective imaging marker for this vascular compensatory process. The present study proposes a novel analytical method to quantify enlarged EDMV volumes in the affected hemisphere of patients with unilateral SWS.
Twenty young subjects, including 10 patients with unilateral SWS and 10 healthy siblings (age 14.5±6.7 and 16.0±7.0 years, respectively) underwent 3T brain MRI scanning using susceptibility-weighted imaging (SWI) and volumetric T1-weighted sequences. The proposed image analytic steps segmented EDMVs in white matter regions, defined on the volumetric T1-weighted images, by statistically associating the likelihood of intensity, location, and tubular shape on SWI. The volumes of the segmented EDMVs, calculated in each hemisphere, were compared between affected and unaffected hemispheres. EDMV volumes were also correlated with visually assessed EDMV scores, hemispheric white matter volumes, and cortical surface areas. Parametric tests including Pearson's correlation, unpaired and paired t-tests, were used. A P value <0.05 was considered statistically significant.
It was found that EDMVs were identified well in SWS-affected hemispheres while calcified regions were excluded. Mean EDMV volumes in the SWS-affected hemispheres were 10-12-fold greater than in the unaffected or healthy control hemispheres; while white matter volumes and cortical surface areas were lower. EDMV volumes in the SWS-affected hemispheres showed a strong positive correlation with the visual EDMV scores (r=0.88, P=0.001) and an inverse correlation with cortical surface area ratios (r=-0.65, P=0.04) but no correlation with white matter volume ratios.
EDMVs were detected in the SWS-affected atrophic hemispheres reliably while avoiding calcified regions. The approach can be used to quantify enlarged deep cerebral veins in the human brain, which may provide a potential marker of cerebral venous remodeling.
患有斯特奇-韦伯综合征（SWS）的患者，其深部髓静脉增粗（EDMVs）可能将静脉血从脑膜静脉畸形所累及脑区的表面引流至深部静脉系统。因此，量化EDMVs的体积可为这一血管代偿过程提供一个客观的影像学标志物。本研究提出了一种新的分析方法，用于量化单侧SWS患者患侧半球增粗的EDMVs的体积。
20名年轻受试者，包括10例单侧SWS患者和10名健康同胞（年龄分别为14.5±6.7岁和16.0±7.0岁），接受了3T脑磁共振成像扫描，采用了磁敏感加权成像（SWI）和容积T1加权序列。所提出的图像分析步骤通过在SWI上对强度、位置和管状形状的可能性进行统计学关联，在容积T1加权图像上定义的白质区域中分割出EDMVs。比较每个半球分割出的EDMVs的体积在患侧和未患侧半球之间的差异。EDMVs的体积还与视觉评估的EDMV评分、半球白质体积和皮质表面积相关。使用了包括Pearson相关性、成组和配对t检验在内的参数检验。P值<0.05被认为具有统计学意义。
发现在SWS累及的半球中能很好地识别出EDMVs，同时排除了钙化区域。SWS累及半球的平均EDMV体积比未累及或健康对照半球大10至12倍；而白质体积和皮质表面积较低。SWS累及半球的EDMV体积与视觉EDMV评分呈强正相关（r=0.88，P=0.001），与皮质表面积比呈负相关（r=-0.65，P=0.04），但与白质体积比无相关性。
在SWS累及的萎缩半球中能可靠地检测到EDMVs，同时避开钙化区域。该方法可用于量化人脑深部脑静脉增粗的情况，这可能为脑静脉重塑提供一个潜在标志物。
