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Cerebral Small Vessel Disease

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Hybrid PET/MR Neuroimaging

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Abstract

Cerebral small vessel disease (SVD) of the brain is a disorder of the small vessels in the brain including arterioles, capillaries, and venules [1]. Histologically, vessels were classified based on the thickness of their walls without a clear distinction about their diameter. With the understanding of the pathophysiology of ischemic disease and the TOAST classification in 1993 [2], the concept of small vessel and large vessel disease became popular. The exact definitions of small vessels remain unclear, but often small vessels include small muscular arteries and large sized arterioles more than capillaries and venules. Typically, arterioles have a diameter of 10–100 μm, and deep perforating and leptomeningeal arteries are approximately 50–800 μm [3]. Prior to advent of brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT), SVD was only diagnosed on pathological examination [4]. These lesions are often clinically silent but can be associated with cognitive impairment, dementia, depression, increased risk of stroke, worse outcome after stroke, and gait abnormalities. Small vessel disease-related brain damage is not confined to visible lesions but also can occur in normal appearing white matter and gray matter as evidenced by more sensitive MRI methods and histopathological studies. The term neurovascular unit (NVU) coined by the Stroke Progress Review Group [5] consists of neurons, astrocytes, endothelial cells, pericytes, and vascular smooth muscle cells. From what is known thus far, NVU regulates the blood-brain barrier (BBB), and its role in cerebrovascular and neurodegenerative diseases is currently studied [6]. SVD is a dynamic process which can progress or regress based on the balance between neural protective mechanisms and vascular risk factors.

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Authors and Affiliations

  1. Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA

    Bhanu Gogia & Anand V. Patel

  2. Department of Neurology, Northwell Health, Manasset, NY, USA

    Richard B. Libman

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  1. Bhanu Gogia
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  2. Richard B. Libman
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  3. Anand V. Patel
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Correspondence to Anand V. Patel .

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Editors and Affiliations

  1. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institutes for Medical Research, Manhasset, NY, USA

    Ana M. Franceschi

  2. Stony Brook University Hospital, Stony Brook, NY, USA

    Dinko Franceschi

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Gogia, B., Libman, R.B., Patel, A.V. (2022). Cerebral Small Vessel Disease. In: Franceschi, A.M., Franceschi, D. (eds) Hybrid PET/MR Neuroimaging. Springer, Cham. https://doi.org/10.1007/978-3-030-82367-2_66

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  • DOI: https://doi.org/10.1007/978-3-030-82367-2_66

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