There are two main forms of CSVD which includes amyloidal CSVD and non-amyloidal CSVD (age-related and vascular risk-factor-related small vessel, i.e., arteriolosclerosis). Moreover, conventional vascular risk factors such as hypertension, diabetes, hyperlipidaemia and smoking have been shown to increase the risk towards development and progression of CSVD. Consequently, CSVD imposes a significant impact on neuropsychological function as well as common neuropathological processes, and contributes significantly to development of cognitive impairment, dementia, and stroke. Due to various vascular-pathologic developments that could disrupt the perforating cerebral capillaries and arteries that supply the brain subcortical region with restricted collaterals, parenchymal damage is seen in the grey and deep white matter of the subcortical area (as shown in Figure 1). As we strive to better understand this complex condition, this mini review will summarise the recent advances and prospects of DTI pipeline application for the clinical detection and assessment of the cerebral white matter integrity.ĬSVD is widely recognised as a neurovascular syndrome featuring clinical, cognitive, neuroimaging, and neuropathological findings that arise from damage and/disruption involving a complex neurogliovascular unit in the brain. Various sets of computerized software or image pipeline processing ( i.e., from dMRI data capture to image processing and data interpretation) are used along the process due to a lack of standardization and variability in the reported findings. One of the more current improvements in DTI is the advancement of models of individual patient-specific white matter tracts, namely the diffusion tensor tractography, which is thought to be suitable to examine the effect of CSVD on white matter tracts. Within dMRI, diffusion tensor imaging (DTI) offers data that can be used to explain brain white matter connections non-invasively through fiber tracking. Therefore, improved relationships and reliable lesion studies are desired to enhance the assessment of white matter architecture and connectivity such as white matter tractography using diffusion-based MRI (dMRI). While conventional MRI and MRI-based diffusion-weighted imaging (DWI) provide a detailed picture of the overall severity of white matter involvement, it is only capable of measuring diffusion in a single direction. Sporadic CSVD pathologies are often heterogeneous, as evidenced by neuroimaging findings such as lacunes, white matter hyperintensities and enlarged perivascular spaces on T2-weighted magnetic resonance imaging (MRI). In this minireview, we highlight the advances in DTI pipeline processing and the prospect of this DTI metrics as potential imaging biomarker for CSVD, even for subclinical CSVD in at-risk individuals.Ĭerebral small vessel disease (CSVD), in its prevalent sporadic form, refers to a syndrome of clinical and neuroimaging findings in ageing populations that is frequently related to vascular risk factors and onset of neurological impairments including stroke, dementia, parkinsonism, gait problems, and mood disturbances. However, due to a lack of standardization on various sets of software or image pipeline processing utilized in this technique that driven mostly from research setting, interpreting the findings remain contentious, especially to inform an improved diagnosis and/or prognosis of CSVD for routine clinical use. Diffusion tensor imaging (DTI) and tractography is an application of dMRI that provides data that can be used to non-invasively appraise the brain white matter connections via fiber tracking and enable visualization of individual patient-specific white matter fiber tracts to reflect the extent of CSVD-associated white matter damage. Enhanced relationships and reliable lesion studies, such as white matter tractography using diffusion-based MRI (dMRI) are necessary in order to improve the assessment of white matter architecture and connectivity in CSVD. Despite a progress on its key pathophysiological bases and general acceptance of key terms from neuroimaging findings as observed on the magnetic resonance imaging (MRI), key questions on CSVD remain elusive. Cerebral small vessel disease (CSVD) is a leading cause of age-related micro vascular cognitive decline, resulting in significant morbidity and decreased quality of life.
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