title: Prominence of Medullary Veins on Susceptibility-Weighted Images Provides Prognostic Information in Patients with Subacute Stroke.
abstract: OBJECTIVE
  The demonstration of prominent medullary veins in the deep white matter ipsilateral to acute ischemic stroke has been shown to predict poor clinical outcome. We have investigated the prognostic implications of prominent medullary veins in patients with subacute stroke who present outside the therapeutic window for revascularization therapy.
  
  
  METHODS
  Forty-three consecutive patients with ischemic stroke in the middle cerebral artery territory presenting within 3-7 days of ictus were enrolled. The presence of prominent medullary veins in the periventricular white matter of the ipsilateral and contralateral medullary vein hemispheres was recorded. Perfusion-weighted imaging was used to calculate differences in hemispheric CBF from corresponding areas. Clinical outcome was classified as good if the modified Rankin Scale score was <3.
  
  
  RESULTS
  Prominent medullary veins were observed in 24/43 patients with 14 ipsilateral medullary veins and 10 contralateral medullary veins. The ipsilateral medullary vein was independently associated with poor outcome (odds ratio, 11.19; P = .046). The contralateral medullary vein was not independently predictive of outcome but was significantly more common in patients with good outcome (90.0% contralateral medullary veins). A mean 64.5% decrease and a 52.4% increase of differences in hemispheric CBF were found in ipsilateral medullary veins and contralateral medullary veins, respectively.
  
  
  CONCLUSIONS
  The ipsilateral medullary vein was a significant predictive biomarker of poor clinical outcome after stroke and was associated with hypoperfusion. The contralateral medullary vein was associated with good clinical outcome, and we hypothesize that prominent contralateral medullary veins indirectly reflect increased CBF in the ipsilateral hemisphere due to spontaneous recanalization or collateral flow.
authors.affiliation: From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.).
authors.forename: X
authors.identifier: http://orcid.org/0000-0001-6024-8591
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Biomedical Engineering and Instrument Science (L.Y.), Key Laboratory for Biomedical Engineering of Education Ministry of China, Zhejiang University, Hangzhou, China.
authors.forename: L
authors.identifier: http://orcid.org/0000-0002-8650-9451
authors.initials: L
authors.lastname: Yuan
authors.affiliation: Wolfson Molecular Imaging Centre (A.J.), University of Manchester, Manchester, United Kingdom.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-1623-0383
authors.initials: A
authors.lastname: Jackson
authors.affiliation: From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.).
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-8682-3504
authors.initials: J
authors.lastname: Sun
authors.affiliation: From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.).
authors.forename: P
authors.identifier: http://orcid.org/0000-0003-4226-9369
authors.initials: P
authors.lastname: Huang
authors.affiliation: From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.).
authors.forename: X
authors.identifier: http://orcid.org/0000-0001-6811-9997
authors.initials: X
authors.lastname: Xu
authors.affiliation: Neurology (Y.M., M.L.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Y
authors.identifier: http://orcid.org/0000-0001-7547-9253
authors.initials: Y
authors.lastname: Mao
authors.affiliation: Neurology (Y.M., M.L.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-6627-064X
authors.initials: M
authors.lastname: Lou
authors.affiliation: Department of Neurology (Q.J.), Henry Ford Health System, Detroit, Michigan.
authors.forename: Q
authors.identifier: http://orcid.org/0000-0001-7908-4443
authors.initials: Q
authors.lastname: Jiang
authors.affiliation: From the Departments of Radiology (X.Y., J.S., P.H., X.X., M.Z.) zhangminming@zju.edu.cn.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-0145-7558
authors.initials: M
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D011379:Prognosis; D020521:Stroke / Q000473:pathology*; D014680:Veins / Q000473:pathology*