ORIGINAL RESEARCH article
Front. Hum. Neurosci.
Sec. Brain Imaging and Stimulation
Volume 19 - 2025 | doi: 10.3389/fnhum.2025.1636248
This article is part of the Research TopicExploring the complexities of the human nervous system through advanced brain imaging and stimulationView all 7 articles
Deep Medullary Vein Dysfunction Is Associated With Cerebral Microbleeds in Cerebral Small Vessel Disease
Provisionally accepted
- 1lishui, Lishui, China
- 2Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, lishui, China
- 3Tongde Hospital of Zhejiang Province, Hangzhou, China
- 4Lishui City People's Hospital, Lishui, China
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Objective: This study investigated the association between deep medullary vein (DMV) dysfunction and the development of cerebral microbleeds (CMB) in patients with cerebral small vessel disease (CSVD), with a particular focus on the contribution of extracellular fluid accumulation.This was a cross sectional study. Clinical and imaging data from 176 patients with CSVD were consecutively collected between July 2024 and May 2025. DMV visibility was scored on a scale of 0-18 using susceptibility-weighted imaging (SWI). CMB were quantified on SWI magnitude images and categorized into three groups: absent CMB, mild CMB (1-2 lesions), and extensive CMB (≥3 lesions). Extracellular fluid volume was estimated using free water (FW) values derived from diffusion tensor imaging. Associations between DMV scores, FW values, and CMB burden were evaluated.Results: DMV scores were moderate positively correlated with both CMB burden and FW values (r = 0.460, P < 0.001; r = 0.549, P < 0.001, respectively), as well as between FW values and CMB burden (r = 0.561, P < 0.001). Patients in the extensive CMB group had significantly higher DMV scores and FW values compared to those in the absent CMB and mild CMB groups. Mediation analysis demonstrated that FW acted as a partial mediator in the relationship between DMV scores and CMB burden (β = 0.088, 95%CI: 0.048-0.152, P < 0.05). This mediating effect remained statistically significant after adjusting for age, sex, hypertension, diabetes, smoking, and hyperlipidemia (β = 0.054, 95%CI: 0.022-0.107, P < 0.05).DMV dysfunction is positively associated with CMB burden in CSVD, partially mediated by increased extracellular fluid accumulation. These findings suggest that impaired venous drainage and interstitial fluid retention may play a role in the pathogenesis of CMB.
Keywords: Cerebral small vessel disease, deep medullary veins, cerebral microbleeds, Extracellular Fluid, Susceptibility weighted imaging
Received: 27 May 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Lan, Lei, Xu, Yu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Haiyuan Lan, lishui, Lishui, China
Huimei Wang, Lishui City People's Hospital, Lishui, China
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