Alterations of the cerebral cortex in sporadic small vessel disease: A systematic review of in vivo MRI data

J Cereb Blood Flow Metab. 2016 Apr;36(4):681-95. doi: 10.1177/0271678X15625352. Epub 2016 Jan 19.


Cerebral small vessel diseases of the brain are a major determinant of cognitive impairment in the elderly. In small vessel diseases, the most easily identifiable lesions, both at post-mortem evaluation and magnetic resonance imaging, lie in subcortical areas. However, recent results obtained post-mortem, particularly in severe cases, have highlighted the burden of cortex lesions such as microinfarcts and diffuse neuronal loss. The recent development of image post-processing methods allows now assessing in vivo multiple aspects of the cerebral cortex. This systematic review aimed to analyze in vivo magnetic resonance imaging studies evaluating cortex alterations at different stages of small vessel diseases. Studies assessing the relationships between small vessel disease magnetic resonance imaging markers obtained at the subcortical level and cortex estimates were reviewed both in community-dwelling elderly and in patients with symptomatic small vessel diseases. Thereafter, studies analyzing cortex estimates in small vessel disease patients compared with healthy subjects were evaluated. The results support that important cortex alterations develop along the course of small vessel diseases independently of concomitant neurodegenerative processes. Easy detection and quantification of cortex changes in small vessel diseases as well as understanding their underlying mechanisms are challenging tasks for better understanding cognitive decline in small vessel diseases.

Keywords: Cerebral small vessel disease; cortex; cortical folding; cortical thickness; magnetic resonance imaging; voxel-based morphometry.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Animals
  • Cerebral Cortex / pathology*
  • Cerebral Small Vessel Diseases / pathology*
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging / methods*