Comprehensive Imaging Review of Deep Medullary Veins

Deep medullary veins are essential components of the venous drainage system of the brain intricately interwoven within the cerebral white matter. These veins drain into subependymal veins, forming a distinctive wedge-shaped pattern. Various disorders are closely associated with deep medullary veins and often present with characteristic lesion patterns. When lesions display a parallel or radial configuration within the deep white matter, it is critical to include pathologies involving these veins in the differential diagnosis. A broad range of diseases can affect the medullary veins, encompassing vascular conditions such as developmental venous anomalies, Sturge-Weber syndrome, stroke, cerebral small-vessel disease, and Moyamoya disease. Inflammatory disorders, including MS, neurosarcoidosis, and acute disseminated encephalomyelitis, also involve these veins. Additionally, neoplastic conditions like intravascular lymphoma and genetic disorders such as metachromatic leukodystrophy further illustrate the diverse spectrum of pathologies associated with the deep medullary veins. This article aims to elucidate the complex interplay between the anatomy and pathology of the deep medullary veins, highlighting their diagnostic and clinical relevance across a range of congenital and acquired conditions, inflammatory processes, and neoplasms. By examining these relationships, we seek to enhance the understanding of these critical venous structures and improve diagnostic accuracy in conditions that affect them.Learning Objective: To understand the anatomy of deep medullary veins; familiarize oneself with the role of deep medullary veins in the pathogenesis of disease development and progression; and finally achieve a topographic correlation of the imaging manifestations of these diseases with the anatomic distribution of deep medullary veins.