Table 1.
Technical validation status in cSVD patients, strengths, and weaknesses of advanced MRI techniques.
| Technique | Potential applications | Technical validation | Strengths | Weaknesses |
|---|---|---|---|---|
| Advanced structural imaging | ||||
| Diffusion MRI (in particular DTI metrics) |
Monitoring disease progression over time, endpoint in
clinical trials8,9
Prediction of dementia10 |
High scan-rescan repeatability in cSVD patients High inter-site reproducibility when using harmonized acquisition11 |
Widely available and straightforward to
implement Short acquisition time when using multiband imaging Fully automated analysis possible (e.g., PSMD)8 |
Especially prone to motion artifacts and CSF
contamination12
High degree of harmonization needed for comparability across sites13 |
| Quantitative MRI (relaxometry, iron, myelin) |
Measuring tissue composition14–16 and repair17 | Limited data in cSVD patients | Post-mortem validation18,19 | Typically needs long acquisition time or research sequences20 |
| Cerebrovascular integrity and function | ||||
| DCE-MRI | Monitoring disease progression, improve prognosis, personalize medications21,22 | Limited data concerning repeatability and reproducibility in cSVD patients | Ability to detect small changes in permeability with good spatial resolution | Complicated technique with low signal-to-noise ratio |
| CVR-MRI | Monitoring disease progression, improve prognosis, personalize medications21,22 | Limited data concerning repeatability and reproducibility in cSVD patients | Excellent spatial resolution in detection of vascular
reactivity Good tolerability |
Care needed in image registration. High degree of harmonization needed for comparability across sites |
| Imaging of small perforating arteries | ||||
| Perforating artery morphology and flow velocity | Provide insight in cSVD pathogenesis23,24
Potential (treatable) endpoint in clinical trials at the level of the small vessels |
Scan-rescan repeatability and inter-scanner reproducibility are topic of ongoing studies | Imaging at the level of small vessel pathology
itself Potential to identify small vessel changes before permanent parenchymal damage occurs |
Limited availability of 7 T systems Potentially more claustrophobic than 3 T scanner Prone to motion, given the high resolution and relatively long scan time |
cSVD: cerebral small vessel disease; MRI: magnetic resonance imaging; DTI: diffusion tensor imaging; DCE-MRI: dynamic contrast enhanced MRI; CVR-MRI: cerebrovascular reactivity MRI; CSF: cerebrospinal fluid; PSMD: peak width of skeletonized mean diffusivity.