To characterize the change of deep medullary veins on 3T susceptibility weighted imaging (SWI) in a large population-based cohort, and to investigate its potential risk factors and association with the risk of stroke as well as association with traditional imaging markers of cerebral small vessel disease (CSVD).

Identifying in vivo marker of the tiny blood vessel is important for understanding and preventing cerebral small vessel disease which is common in older adults causing stroke, cognitive decline,and age-related disability. Periventricular venous abnormalities have been implicated in brain parenchymal damage in the context of CSVD in both autopsies and in vivo studies.

This study included clinically normal participants from the Shunyi Study, an ongoing prospective community-based cohort in Beijing. Baseline demographic and medical data to quantify risk factors and baseline MRI data were acquired beginning in 2013 and participants were followed annually. Macroscopic veins were counted in the periventricular white matter of each hemisphere on reconstructed SWI. Traditional imaging markers of CSVD were defined according to the Standards for Reporting Vascular Changes on Neuroimaging (STRIVE).

Of the 1114 participants, the mean (±SD) age was 55.2 (±9.6) years, 405 (36.4%) were male and mean follow-up time was 2.3 years. The number of deep medullary veins decreased gradually with age and minimally changed when adjusting for vascular risk factors. Loss of deep medullary vein was not associated with traditional vascular risk factors, neither with the risk of stroke as well. Reduced deep medullary veins were most strongly associated with smaller brain parenchymal volume, and significantly associated with more white matter hyperintensity, but not with the presence of lacunes, microbleeds or severe dilated perivascular space.

Reduced deep medullary veins might complement imaging marker of age-related CSVD and play a role in brain atrophy. Prognostic value and clinical significance of this venous change warrants further investigations.