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Differences in subependymal vein anatomy may predispose preterm infants to GMH–IVH
  1. Domenico Tortora1,
  2. Mariasavina Severino1,
  3. Mariya Malova2,
  4. Alessandro Parodi2,
  5. Giovanni Morana1,
  6. Jan Sedlacik3,
  7. Paul Govaert4,5,
  8. Joseph J Volpe6,
  9. Andrea Rossi1,
  10. Luca Antonio Ramenghi2
  1. 1 Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
  2. 2 Neonatal Intensive Care Unit, Istituto Giannina Gaslini, Genoa, Italy
  3. 3 Department of Neuroradiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
  4. 4 Section of Neonatology, Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  5. 5 ZNA Koningin Paola Kinderziekenhuis, Antwerp, Belgium
  6. 6 Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Andrea Rossi, Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, Genoa 16147, Italy; andrearossi{at}


Background and purpose The anatomy of the deep venous system plays an important role in the pathogenesis of brain lesions in the preterm brain as shown by different histological studies. The aims of this study were to compare the subependymal vein anatomy of preterm neonates with germinal matrix haemorrhage–intraventricular haemorrhage (GMH–IVH), as evaluated by susceptibility-weighted imaging (SWI) venography, with a group of age-matched controls with normal brain MRI, and to explore the relationship between the anatomical features of subependymal veins and clinical risk factors for GMH–IVH.

Methods SWI venographies of 48 neonates with GMH–IVH and 130 neonates with normal brain MRI were retrospectively evaluated. Subependymal vein anatomy was classified into six different patterns: type 1 represented the classic pattern and types 2–6 were considered anatomic variants. A quantitative analysis of the venous curvature index was performed. Variables were analysed by using Mann-Whitney U and χ2 tests, and a multiple logistic regression analysis was performed to evaluate the association between anatomical features, clinical factors and GMH–IVH.

Results A significant difference was noticed among the six anatomical patterns according to the presence of GMH–IVH (χ2=14.242, p=0.014). Anatomic variants were observed with higher frequency in neonates with GMH–IVH than in controls (62.2% and 49.6%, respectively). Neonates with GMH–IVH presented a narrower curvature of the terminal portion of subependymal veins (p<0.05). These anatomical features were significantly associated with GMH–IVH (p<0.05).

Conclusion Preterm neonates with GMH–IVH show higher variability of subependymal veins anatomy confirming a potential role as predisposing factor for GMH–IVH.

  • preterm birth
  • cerebral veins
  • intraventricular hemorrhage
  • germinal matrix hemorrhage

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  • Contributors DT conceptualised and designed the study, drafted the manuscript, performed statistical analysis and approved the final manuscript as submitted. MS, MM, AP, GM and JS conceptualised the study, implemented the imaging sequence and venographic image reconstruction method, carried out the initial analysis, reviewed and revised the manuscript and approved the final manuscript as submitted. PG and JJV conceptualised the study, critically reviewed the manuscript and approved the final manuscript as submitted. AR and LAR conceptualised the study, coordinated and supervised data collection, critically reviewed the manuscript and approved the final manuscript as submitted.

  • Funding This research was supported by the Eu-Brain non-profit association.

  • Competing interests None declared.

  • Ethics approval Gaslini Institute review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.