ABSTRACT NUMBER: ESOC2026OT180 EARLYPROG-SVD: ESTABLISHING MRI BIOMARKERS FOR EARLY DISEASE PROGRESSION IN CEREBRAL SMALL VESSEL DISEASE – INTERIM IMAGING RESULTS

Abstract Background and aims Cerebral small vessel disease (SVD) is a leading cause of vascular dementia and accounts for 25% of ischemic strokes. Despite white matter hyperintensities (WMH) of similar severity, clinical manifestations vary considerably between individuals, suggesting that microstructural changes beyond macroscopic lesions are critical. Quantitative MRI (qMRI) techniques may detect such changes before overt clinical deterioration; even earlier than known diffusion tensor imaging (DTI) markers. Methods EARLYPROG-SVD (DRKS00034274) aims to establish imaging biomarkers for early disease progression by investigating microstructural tissue integrity using qMRI relaxometry and DTI in affected and normal-appearing brain tissue over time. Results In this prospective longitudinal study, 38 patients (mean age 68.5±5.9 years; mean Fazekas score ≥2.5, rated by two blinded raters) and 33 age-matched controls (mean age 70.8±6.9 years; p=n.s.) aged ≥60 at inclusion underwent 3T MRI, comprehensive clinical assessment, and cognitive testing (CERAD-Plus) at three close-interval time points (baseline, 6 months, and ~12-18 months). Automated WMH segmentation and quantitative T1, T2, T2*, and T2' relaxometry are performed to compare values across brain regions and groups. Subsequent analyses will incorporate DTI-based tractography. Conclusions Cardiovascular risk factors differed significantly between groups, with higher prevalence of hypertension (p=0.002), dyslipidemia (p=0.015), and cardiac comorbidity (p=0.045), alongside a non-significant trend for diabetes. Analyses of WMH distribution patterns and quantitative values in white matter lesions and cortex will be presented. Conflict of interest