Intracranial vessel wall lesions on 7T MRI and MRI features of cerebral small vessel disease-The SMART-MR study

Maarten Ht Zwartbol, Anja G van der Kolk, Hugo J Kuijf, Theo D Witkamp, Rashid Ghaznawi, Jeroen Hendrikse, Mirjam I Geerlings,

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The etiology of cerebral small vessel disease (CSVD) is the subject of ongoing research. Although intracranial atherosclerosis (ICAS) has been proposed as a possible cause, studies on their relationship remain sparse. We used 7 T vessel wall magnetic resonance imaging (MRI) to study the association between intracranial vessel wall lesions-a neuroimaging marker of ICAS-and MRI features of CSVD. Within the SMART-MR study, cross-sectional analyses were performed in 130 patients (68 ± 9 years; 88% male). ICAS burden-defined as the number of vessel wall lesions-was determined on 7 T vessel wall MRI. CSVD features were determined on 1.5 T and 7 T MRI. Associations between ICAS burden and CSVD features were estimated with linear or modified Poisson regression, adjusted for age, sex, vascular risk factors, and medication use. In 125 patients, ≥1 vessel wall lesions were found (mean 8.5 ± 5.7 lesions). ICAS burden (per + 1 SD) was associated with presence of large subcortical and/or cortical infarcts (RR = 1.65; 95%CI: 1.12-2.43), lacunes (RR = 1.45; 95% CI: 1.14-1.86), cortical microinfarcts (RR = 1.48; 95%CI: 1.13-1.94), and total white matter hyperintensity volume (b = 0.24; 95%CI: 0.02-0.46). Concluding, patients with a higher ICAS burden had more CSVD features, although no evidence of co-location was observed. Further longitudinal studies are required to determine if ICAS precedes development of CSVD.

Original languageEnglish
Pages (from-to)1219-1228
Number of pages10
JournalJournal of Cerebral Blood Flow and Metabolism
Issue number6
Early online date6 Oct 2020
Publication statusPublished - 1 Jun 2021


  • cerebral small vessel disease
  • Intracranial atherosclerosis
  • lacunes of presumed vascular origin
  • vessel wall imaging
  • white matter hyperintensities


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