AES-SDM meta-analysis of spontaneous brain activity in cerebral small vessel disease

Cerebral small vessel disease (CSVD) is a major cause of vascular cognitive impairment and dementia, characterized by microvascular dysfunction and disruption of cortico-subcortical circuits. Although resting-state functional magnetic resonance imaging (rs-fMRI) studies have reported altered spontaneous brain activity in CSVD, their findings remain inconsistent across studies. A coordinate-based meta-analysis was performed using Anisotropic Effect-Size Signed Differential Mapping (AES-SDM) to quantitatively synthesize rs-fMRI studies investigating spontaneous neural activity in patients with CSVD. Relevant literature published up to October 19, 2025 was systematically retrieved from PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang. Studies reporting between-group differences in local spontaneous brain activity were included. A random-effects model was applied with thresholds of uncorrected p < 0.005, peak height Z > 1, and cluster extent ≥ 5 voxels. Heterogeneity, sensitivity, and publication bias were assessed using Q/I² tests, Jackknife analysis, and Egger’s test, respectively. Nine studies comprising 277 CSVD patients and 287 healthy controls were included. Compared with controls, CSVD patients exhibited increased spontaneous brain activity in the bilateral postcentral gyri, bilateral precuneus, and left inferior frontal gyrus. No brain regions showed decreased activity. Egger’s test indicated no significant publication bias (all p > 0.05), and Jackknife analysis confirmed the stability of results across all iterations. This AES-SDM meta-analysis identified convergent increases in spontaneous brain activity in the somatosensory cortex, precuneus, and inferior frontal gyrus in CSVD. These results provide neuroimaging evidence of functional disruption in CSVD and help clarify the neural substrates potentially associated with its clinical manifestations.