Dados do Trabalho

Título

Neuroimaging Markers of Cerebral Small Vessel Disease : a Practical Guide.

Descrição sucinta do(s) objetivo(s)

To provide a detailed and up-to-date overview of the neuroimaging markers of cerebral small vessel diseases (CSVD) focusing on the radiology and neuroradiology trainees. We discuss the typical CSVD imaging features on conventional magnetic resonance imaging (MRI) sequences, and provide a brief review of their clinical, prognostic and etiological relevance in daily practice.

Descrição da(s) doença(s), método(s) e/ou técnica(s)

CSVD are characterized by microvascular structural and functional changes that ultimately contribute to an increased risk of stroke, vascular cognitive impairment and dementia. Data on how common CSVD markers are in Brazilian populations are largely missing, but the overall prevalence seems high in low- and middle-income countries. As a means to raise awareness about the current arsenal of neuroimaging features related to CSVD, we performed a literature review of the imaging and clinical aspects of each one of its MRI markers.

Discussão

CSVD MRI biomarkers can be stratified as follows: (1) non-hemorrhagic markers, which include recent small subcortical infarcts, lacunes of presumed vascular origin, white matter hyperintensities of presumed vascular origin, perivascular spaces and microinfarcts; and (2) hemorrhagic markers, such as cerebral microbleeds, cortical superficial siderosis and intracerebral hemorrhage. We summarize and discuss each one of these markers individually, considering their appearance on conventional MRI sequences, their possible pathophysiology, most commonly reported risk factors and their impact on prognosis. Moreover, these neuroimaging markers also contribute to the diagnosis of different subtypes of CSVD, and play a major role in differentiating arteriosclerosis and cerebral amyloid angiopathy (CAA), the two most common types of CSVD in clinical practice. While arteriosclerosis usually affects the deep perforator arteries of the brain, and therefore is usually encountered in the deep brain areas, CAA is usually associated with cortical microbleeds, cortical superficial siderosis and intracerebral lobar hemorrhages. Lastly, we review the role of two clinical-radiological criteria developed to allow in vivo diagnosis of CAA, named the Boston Criteria version 2.0 and the simplified Edinburgh Criteria.

Conclusões

CSVD are highly prevalent conditions with potentially devastating clinical consequences. Therefore, every radiologist should be familiar with these conditions and their typical neuroradiological features.

Palavras Chave

cerebral small vessel disease; dementia; stroke

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