Abstract
SUMMARY: Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. Despite being almost ubiquitous in brain imaging, the clinicoradiologic association of small vessel disease is weak, and the underlying pathogenesis is poorly understood. The STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria have standardized the nomenclature. These include white matter hyperintensities of presumed vascular origin, recent small subcortical infarcts, lacunes of presumed vascular origin, prominent perivascular spaces, cerebral microbleeds, superficial siderosis, cortical microinfarcts, and brain atrophy. Recently, the rigid categories among cognitive impairment, vascular dementia, stroke, and small vessel disease have become outdated, with a greater emphasis on brain health. Conventional and advanced small vessel disease imaging markers allow a comprehensive assessment of global brain heath. In this review, we discuss the pathophysiology of small vessel disease neuroimaging nomenclature by means of the STRIVE criteria, clinical implications, the role of advanced imaging, and future directions.
ABBREVIATIONS:
- BOLD
- blood oxygen level–dependent
- CAA
- cerebral amyloid angiopathy (SVD type 2)
- CMB
- cerebral microbleeds
- cSS
- cortical superficial siderosis
- HA
- hypertensive arteriolosclerosis (SVD type 1)
- ICH
- intracerebral hemorrhage
- PVS
- prominent perivascular spaces
- STRIVE
- STandards for ReportIng Vascular changes on nEuroimaging
- SVD
- small vessel disease
- WMH
- white matter hyperintensities
Footnotes
Disclosures: Pooja Khatri—RELATED: Grant: National Institutes of Health.* UNRELATED: Consultancy: Lumosa Therapeutics, Diamedica Therapeutics*; Grants/Grants Pending: Cerenovus*; Royalties: UpToDate; Other: Bayer, Basking Biosciences, Comments: Bayer, National Trial Leader; Basking Biosciences, Scientific Advisory Board. Brett Kissela—RELATED: Grant: National Institutes of Health/National Institute of Neurological Disorders and Stroke.* Rhonna Shatz—RELATED: Grant: National Institutes of Health.* Achala Vagal—RELATED: Grant: National Institutes of Health, Cerenovus,* Comments: R01, National Institutes of Health/National Institute of Neurological Disorders and Stroke,* NS103824; RF1, National Institute of Neurological Disorders and Stroke/National Institute on Aging, NS117643; R01, National Institutes of Health/National Institute of Neurological Disorders and Stroke, NS100417; National Institutes of Health/National Institute of Neurological Disorders and Stroke, 1U01NS100699; National Institutes of Health/National Institute of Neurological Disorders and Stroke, U01NS110772; Principal Investigator, Imaging Core Lab, ENDOLOW Trial, Cerenovus. *Money paid to the institution.
- © 2021 by American Journal of Neuroradiology
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