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Our purpose is to assess the role of deep medullary veins (DMVs) in pathogenesis of MRI-visible perivascular spaces (PVS) in patients with cerebral small vessel disease (cSVD). Consecutive patients recruited in the CIRCLE study (ClinicalTrials.gov ID: NCT03542734) were included. Susceptibility Weighted Imaging-Phase images were used to evaluate DMVs based on a brain region-based visual score. T2 weighted images were used to evaluate PVS based on the five-point score, and PVS in basal ganglia (BG-PVS), centrum semiovale (CSO-PVS) and hippocampus (H-PVS) were evaluated separately. 270 patients were included. The severity of BG-PVS, CSO-PVS and H-PVS was positively related to the increment of age (all p  &lt; 0.05). The severity of BG-PVS and H-PVS was positively related to DMVs score (both p  &lt; 0.05). Patients with more severe BG-PVS had higher Fazekas scores in both periventricle and deep white matter (both p  &lt; 0.001) and higher frequency of hypertension ( p  = 0.008). Patients with more severe H-PVS had higher frequency of diabetes ( p  &lt; 0.001). Besides, high DMVs score was an independent risk factor for more severe BG-PVS ( β  = 0.204, p  = 0.001). Our results suggested that DMVs disruption might be involved in the pathogenesis of BG-PVS.

MRI-visible perivascular spaces in basal ganglia but not centrum semiovale or hippocampus were related to deep medullary veins changes