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Vascular Cognitive Impairment

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Imaging Dementia

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Abstract

Main imaging findings:

  • Large ischemic lesions:

    • MRI: hyperintensity on T2-weighted images, FLAIR and DWI and correspondent hypointensity on the ADC maps.

    • CT: No CT findings in early stages (only indirect signs). Hypodensity of the damaged tissue after 6–24 h from clinical onset.

  • White matter hyperintensities:

    • MRI: diffuse and hyperintense lesions on T2-weighted and FLAIR images mainly in periventricular regions and in the centrum semiovale. Normal or hypointense signal in T1-weighted images may be present.

    • CT: hypodense confluent alterations of the white matter.

  • Vascular lacunes:

    • MRI: round or ovoid cavities, filled with fluid and hyperintense on T2-weighted images, hyperintense peripheral rim in FLAIR sequences surrounding an hypointense core.

    • “État criblé”: multiple enlarged perivascular spaces in the basal ganglia.

    • CT: small ovoid hypodensities usually located in deep white matter.

    • Dimension: between 3 and 15 mm.

  • Perivascular spaces:

    • MRI: small, oval with a well-defined smooth margin hyperintensities, isointense to cerebrospinal fluid.

    • Dimension: not larger than 3 mm.

  • Cerebral microbleeds:

    • MRI: visible on conventional T2*-weighted GRE or SWI as intense hypointensities.

    • Main location: deep regions in hypertensive vasculopathy, lobar location in CAA.

  • Brain atrophy:

    • Cortical thinning and diminished brain volume.

    • Enlargement of the ventricles and subarachnoid spaces.

    • Both quantifiable on MRI and CT scans.

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Authors and Affiliations

  1. Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

  2. Vita-Salute San Raffaele University, Milan, Italy

    Massimo Filippi & Federica Agosta

  3. Neuroimaging Research Unit, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Federica Agosta

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  1. Massimo Filippi
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  2. Federica Agosta
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Correspondence to Massimo Filippi .

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Filippi, M., Agosta, F. (2021). Vascular Cognitive Impairment. In: Imaging Dementia. Springer, Cham. https://doi.org/10.1007/978-3-030-66773-3_2

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