Dynamic Mechanism of Cerebral Venous Disruption: Longitudinal Evidence From a Community‐Based Cohort

Background This study aims to investigate the temporal and spatial patterns of structural brain injury related to deep medullary veins (DMVs) damage. Methods and Results This is a longitudinal analysis of the population‐based Shunyi cohort study. Baseline DMVs numbers were identified on susceptibility‐weighted imaging. We assessed vertex‐wise cortex maps and diffusion maps at both baseline and follow‐up using FSL software and the longitudinal FreeSurfer analysis suite. We performed statistical analysis of global measurements and voxel/vertex‐wise analysis to explore the relationship between DMVs number and brain structural measurements. A total of 977 participants were included in the baseline, of whom 544 completed the follow‐up magnetic resonance imaging (age 54.97±7.83 years, 32% men, mean interval 5.56±0.47 years). A lower number of DMVs was associated with a faster disruption of white matter microstructural integrity, presented by increased mean diffusivity and radial diffusion (β=0.0001 and SE=0.0001 for both, P =0.04 and 0.03, respectively), in extensive deep white matter (threshold‐free cluster enhancement P <0.05, adjusted for age and sex). Of particular interest, we found a bidirectional trend association between DMVs number and change in brain volumes. Specifically, participants with mild DMVs disruption showed greater cortical enlargement, whereas those with severe disruption exhibited more significant brain atrophy, primarily involving clusters in the frontal and parietal lobes (multiple comparison corrected P <0.05, adjusted for age, sex, and total intracranial volume). Conclusions Our findings posed the dynamic pattern of brain parenchymal lesions related to DMVs injury, shedding light on the interactions and chronological roles of various pathological mechanisms.