LAUSR

Cerebral small vessel disease (cSVD), a common cause of stroke and dementia, is traditionally considered the small vessel equivalent of large artery occlusion or rupture that leads to cortical and subcortical brain damage. Microvessel endothelial dysfunction has also contributed to it. Brain imaging, including Magnetic Resonance Imaging (MRI), is useful to show the presence of a lesion of several types, although the association between conventional MRI measures and clinical features of cSVD are not always concordant. We assessed the additional contribution of contrast-agent-free, state-of-the-art MRI techniques, Arterial Spin Labeling (ASL), Diffusion Tensor Imaging (DTI), Functional Magnetic Resonance Imaging (fMRI), and Intravoxel Incoherent Motion (IVIM) applied to cSVD in the existing literature. We performed a review following the PICOS worksheet and Search Strategy, including original papers in English, published between 2000 and 2022. For each MRI method, we extracted information about their contributions, in addition to those established with traditional MRI methods and related information about the origins, pathology, markers, and clinical outcomes in cSVD. This paper presents the first part of the review, which includes 37 studies focusing on ASL, IVIM, and cerebrovascular reactivity (CVR) measures. In general, they have shown that, in addition to the white matter hyperintensities, alterations in other neuroimaging parameters such as blood flow and CVR also indicate the presence of cSVD. Such quantitative parameters were also related to cSVD risk factors. Therefore, they are promising, noninvasive tools to explore questions that have not yet been clarified about this clinical condition. However, protocol standardization is essential to increase their clinical use.