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Research ArticleADULT BRAIN

The Internal Cerebral Vein: New Classification of Branching Patterns Based on CTA

K. Brzegowy, M.P. Zarzecki, A. Musiał, H.M. Aziz, T. Kasprzycki, R.S. Tubbs, T. Popiela and J.A. Walocha
American Journal of Neuroradiology September 2019, DOI: https://doi.org/10.3174/ajnr.A6200
K. Brzegowy
aFrom the Department of Anatomy (K.B., M.P.Z., A.M., H.M.A., T.K., J.A.W.), Jagiellonian University Medical College, Krakow, Poland
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  • ORCID record for K. Brzegowy
M.P. Zarzecki
aFrom the Department of Anatomy (K.B., M.P.Z., A.M., H.M.A., T.K., J.A.W.), Jagiellonian University Medical College, Krakow, Poland
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A. Musiał
aFrom the Department of Anatomy (K.B., M.P.Z., A.M., H.M.A., T.K., J.A.W.), Jagiellonian University Medical College, Krakow, Poland
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H.M. Aziz
aFrom the Department of Anatomy (K.B., M.P.Z., A.M., H.M.A., T.K., J.A.W.), Jagiellonian University Medical College, Krakow, Poland
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T. Kasprzycki
aFrom the Department of Anatomy (K.B., M.P.Z., A.M., H.M.A., T.K., J.A.W.), Jagiellonian University Medical College, Krakow, Poland
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R.S. Tubbs
bSeattle Science Foundation (R.S.T.), Seattle, Washington
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T. Popiela
cDepartments of Radiology and Rescue Medicine and Multiorgan Trauma (T.P.), University Hospital, Krakow, Poland.
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J.A. Walocha
aFrom the Department of Anatomy (K.B., M.P.Z., A.M., H.M.A., T.K., J.A.W.), Jagiellonian University Medical College, Krakow, Poland
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  • Fig 1.
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    Fig 1.

    Variations of the ASV–ICV junction and its relation to the foramen of Monro. There are a total of 5 venous angle types (IA, IB, IIA, IIB, III).3 Types I and II refer to the relation of the venous angle to the foramen of Monro (adjacent to or located behind, respectively), whereas types A and B differentiate the ASV located at the venous angle (anteriorly) or beyond it (posteriorly). In type III, the ASV is absent.

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    Fig 2.

    Types of ICV branching patterns. We classified ICV tributaries into 4 types with respect to the main veins draining the basal nuclei. In type 1, only the thalamostriate vein collects blood from the basal nuclei. Types 2 and 3 are characterized by the presence of a suprathalamic or retrothalamic LDV, respectively, which receives tributaries from the striatum. In type 4, the basal vein takes an unusual course and drains the basal nuclei.

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    Fig 3.

    CTA MIP axial cross-sections of the ICV branching patterns. A, Normal ICV anatomy (type 1) in both the left and right hemispheres. The arrow indicates the TSV; the arrowhead, the medial atrial vein. B, The suprathalamic variants of the lateral direct vein (right hemisphere). The arrow indicates the LDV. Type 1 is present in the left hemisphere. C, The retrothalamic LDV (left hemisphere). The arrow indicates the LDV. Type 1 is shown in the right hemisphere.

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    Fig 4.

    CTA MIP axial cross-sections of the ICV branching patterns with an LDV and an absent thalamostriate vein. Arrows indicate LDVs. A, The suprathalamic LDV (type 2; left hemisphere). B, The retrothalamic LDV (type 3; right hemisphere).

Tables

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    Table 1:

    The termination points of the ASVa

    ASV Termination TypeASV TerminationTotal (531 ASVs)
    Type AVenous angle38372.13%
    Type BICV: anterior third7614.31%
    ICV: middle third529.79%
    ICV: posterior third10.19%
    ICV elongation (absent TSV)203.77%
    LDV50.94%
    MAV152.82%
    Cavernous sinus10.19%
    • Note:—MAV indicates medial atrial vein.

    • ↵a Types A and B refer to the classification of ASV–ICV junction proposed by Türe et al (1997),3 and they differentiate between the ASV located at the venous angle (anteriorly) or beyond it (posteriorly).11

    • View popup
    Table 2:

    The termination points of the lateral direct veina

    Branching TypeLDV TerminationTotal (110 LDV)
    Type 2 (a suprathalamic LDV)ICV: anterior third87.27%
    ICV: middle third7063.64%
    ICV: middle third, as a common stem with an MAV21.82%
    Type 3 (a retrothalamic LDV)ICV: posterior third1816.36%
    ICV: posterior third, as a common stem with an MAV87.27%
    Great cerebral vein21.82%
    • Note:—MAV indicates medial atrial vein.

    • ↵a The presence of the LDV characterizes types 2 and 3 of the ICV branching patterns.

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The Internal Cerebral Vein: New Classification of Branching Patterns Based on CTA
K. Brzegowy, M.P. Zarzecki, A. Musiał, H.M. Aziz, T. Kasprzycki, R.S. Tubbs, T. Popiela, J.A. Walocha
American Journal of Neuroradiology Sep 2019, DOI: 10.3174/ajnr.A6200

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The Internal Cerebral Vein: New Classification of Branching Patterns Based on CTA
K. Brzegowy, M.P. Zarzecki, A. Musiał, H.M. Aziz, T. Kasprzycki, R.S. Tubbs, T. Popiela, J.A. Walocha
American Journal of Neuroradiology Sep 2019, DOI: 10.3174/ajnr.A6200
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