Is your doctor testing for this? To implement the protocols to prevent the next stroke and to cure the cerebral small vessel disease? Why not? Isn't your doctor supposed to be competent in all things stroke?
Advanced MRI in cerebral small vessel disease
Abstract
Cerebral small vessel disease (cSVD) is a major cause of stroke and dementia. This review summarizes recent developments in advanced neuroimaging of cSVD with a focus on clinical and research applications.
In the first section we highlight how advanced structural imaging techniques, including diffusion MRI, enable improved detection of tissue damage, including characterization of tissue appearing normal on conventional MRI. These techniques enable progression to be monitored and may be useful as surrogate endpoint in clinical trials. Quantitative MRI, including iron and myelin imaging, provides insights into tissue composition on the molecular level.
In the second section, we cover how advanced MRI techniques can demonstrate functional or dynamic abnormalities of the blood vessels, which could be targeted in mechanistic research and early-stage intervention trials. Such techniques include the use of dynamic contrast enhanced MRI to measure blood-brain barrier permeability, and MRI methods to assess cerebrovascular reactivity.
In the third section we discuss how the increased spatial resolution provided by ultra-high field MRI at 7T allows imaging of perforating arteries, and flow velocity and pulsatility within them.
The advanced MRI techniques we describe are providing novel pathophysiological insights in cSVD and allow improved quantification of disease burden and progression. They have application in clinical trials, both in assessing novel therapeutic mechanisms, and as a sensitive endpoint to assess efficacy of interventions on parenchymal tissue damage. We also discuss challenges of these advanced techniques and suggest future directions for research.
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