Camfferman Fleur A, Govaert Paul, Lequin Maarten H, Groenendaal Floris, Tataranno Maria-Luisa, Kizilates Ufuk, Benders Manon J N L, Dudink Jeroen
From the Department of Neonatology F.A.C., P.G.), UZ Brussel, VUB, Brussels, Belgium; Department of Neonatology (F.G., M.L.T., M.J.N.L.B, J.D.), Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Edward B Singleton Department of Radiology (M.H.L), Texas Children's Hospital, Austin, Texas, USA; Department of Neonatology (P.G.), ZNA Middelheim, Antwerp, Belgium and Department of Radiology (U.K.), Ziekenhuisgroep Twente, The Netherlands.
AJNR Am J Neuroradiol. 2025 Aug 28. doi: 10.3174/ajnr.A8985.
Variability in the deep cerebral venous system is hypothesized to contribute to intraventricular hemorrhage (IVH) in preterm infants. Existing classifications do not adequately capture the range of subependymal venous patterns seen on susceptibility-weighted imaging (SWI) in clinical practice. This study aimed to adapt and expand current classification systems to provide a more comprehensive representation of subependymal vein anatomy in the preterm brain. A secondary aim was to assess maturational changes in venous patterns between 30-and 40-weeks postmenstrual age (PMA) and explore their potential association with GMH-IVH.
We retrospectively analyzed a cohort of extremely preterm infants (born <28 weeks gestation) who underwent cranial MRI with SWI at both 30-and 40-weeks PMA. In total, 88 infants (176 hemispheres) were included. Images were reviewed to determine subependymal venous configuration and to record germinal matrix hemorrhage (GMH), IVH, or periventricular hemorrhagic venous infarction (PHVI). Based on observed anatomical variations-and informed by historical anatomical descriptions- a novel classification system was developed. Changes in anatomy between the two timepoints were also recorded.
Most frequently observed anatomical pattern (new classification system) was type 1A at 30 weeks PMA (31.3%) and type 1A (26.1%) and 2A (25.6%) at 40 weeks PMA. The change of deep venous anatomy seen on SWI between 30-and 40-weeks postmenstrual age was statistically significant (c=28.11; p=0.005). There was no significant relation between subependymal vein type and change in anatomical pattern. Hemorrhage occurred in 79 hemispheres (48.1% GMH, 39.2% IVH and 12.7% PHVI). There was no significant correlation between GMH-IVH-PHVI and anatomical pattern according to the new classification at 30 weeks PMA, neither between GMH-IVH-PHVI and the change of anatomical pattern between 30-and 40-weeks PMA.
This study presents a detailed classification of deep cerebral venous anatomy in extremely preterm infants using SWI at 30-and 40-weeks PMA. Despite observed anatomical variability and maturation, no consistent link was found between venous patterns and GMH-IVH or PHVI. This suggests anatomical variation alone may not strongly influence hemorrhagic injury risk, though limited statistical power may affect this conclusion.
PMA = Postmenstrual age; GMH = Germinal Matrix Hemorrhage; IVH = Intraventricular Hemorrhage; PHVI = Periventricular Hemorrhagic Venous Infarction.
据推测，脑深部静脉系统的变异是导致早产儿脑室内出血（IVH）的原因之一。现有的分类方法未能充分涵盖临床实践中在磁敏感加权成像（SWI）上观察到的室管膜下静脉模式的范围。本研究旨在调整和扩展当前的分类系统，以更全面地呈现早产儿脑室内室管膜下静脉的解剖结构。第二个目的是评估孕龄30至40周之间静脉模式的成熟变化，并探讨它们与生发基质-脑室内出血（GMH-IVH）的潜在关联。
我们回顾性分析了一组极早产儿（出生时孕周<28周），这些婴儿在孕龄30周和40周时均接受了头颅MRI及SWI检查。总共纳入了88名婴儿（176个半球）。对图像进行评估，以确定室管膜下静脉的形态，并记录生发基质出血（GMH）、脑室内出血（IVH）或脑室周围出血性静脉梗死（PHVI）。基于观察到的解剖变异，并参考既往的解剖学描述，开发了一种新的分类系统。同时记录两个时间点之间的解剖结构变化。
最常观察到的解剖模式（新分类系统）在孕龄30周时为1A型（31.3%），在孕龄40周时为1A型（26.1%）和2A型（25.6%）。孕龄30至40周之间SWI上观察到的脑深部静脉解剖结构变化具有统计学意义（c=28.11；p=0.005）。室管膜下静脉类型与解剖模式变化之间无显著关联。79个半球发生了出血（48.1%为GMH，39.2%为IVH，12.7%为PHVI）。在孕龄30周时，根据新分类，GMH-IVH-PHVI与解剖模式之间无显著相关性，在孕龄30至40周之间GMH-IVH-PHVI与解剖模式变化之间也无显著相关性。
本研究详细分类了极早产儿在孕龄30周和40周时使用SWI观察到的脑深部静脉解剖结构。尽管观察到了解剖变异和成熟情况，但未发现静脉模式与GMH-IVH或PHVI之间存在一致的联系。这表明仅解剖变异可能不会强烈影响出血性损伤风险，不过有限的统计效能可能会影响这一结论。
PMA = 孕龄；GMH = 生发基质出血；IVH = 脑室内出血；PHVI = 脑室周围出血性静脉梗死
