MRI signatures associated with active ischemia and disease severity in cerebral small vessel disease

In conclusion, we found evidence that T1 and T2 FLAIR signal is heterogeneous in cerebral small vessel disease and is associated with disease severity. Within WMH, focal T1 hypointensity and variability, as well as T2 FLAIR hyperintensity and variability is associated with ischemia, but not infarction, particularly in larger lesions, suggesting that these patterns of MRI signal follow both disease severity and aberrant physiology. Finally, WMH clustered by structural properties align with specific physiologic patterns suggesting that imaging appearance may reveal underlying ischemic vulnerability. Although these data are exploratory, they suggest that certain categories of WMH with highly ischemic but non-infarcted physiology may represent high-risk tissue that is reversibly injured. Future work will investigate the role these imaging parameters have on clinically relevant outcomes such as incident stroke and cognitive impairment.