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• Clinical Article •
The effects of cerebral small vessel disease total burden severity on cortical and subcortical structure and function
ZHANG Qin  WANG Jie  LI Yunfei  FENG Tianyuyi  WANG Meimei  ZHAO Xiaohu 

DOI:10.12015/issn.1674-8034.2026.02.006.


[Abstract] Objective This study employed structural and resting-state functional MRI techniques to investigate the effects of cerebral small vessel disease (CSVD) total burden severity on the structure and function of cortical regions and subcortical nuclei, and their relationship with cognitive function.Materials and Methods A total of 120 CSVD patients underwent brain MRI scans, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fluid attenuated inversion recovery (FLAIR), susceptibility-weighted imaging (SWI), and resting-state functional MRI (rs-fMRI). Cognitive function was assessed using neuropsychological scales. Four CSVD imaging markers — white matter hyperintensities (WMH), enlarged perivascular spaces (ePVS), lacunes, and cerebral microbleeds (CMBs) — were evaluated on corresponding MRI sequences. A total CSVD burden score (ranging from 0 to 4) was calculated for each patient, who was then divided into four groups (scores 1 to 4). For structural analysis, voxel-based morphometry (VBM) was employed, and region of interest (ROI) were defined using the Schaefer-400 atlas (400 cortical parcels) and the Tian subcortical atlas (32 subcortical nuclei). For functional analysis, regional homogeneity (ReHo) values were computed voxel-wise across the whole brain to assess local neural activity. Analysis of covariance (ANCOVA) was used to compare differences in ROI gray matter volume and ReHo values among the four groups. Spearman's rank correlation analysis was performed to evaluate the association between significant brain regions and cognitive scores.Results Structural MRI analysis revealed a region-specific atrophy pattern, with progressively reduced gray matter volume in the left thalamus (anterior and posterior dorsal nuclei) and left sensorimotor cortices (e.g., precentral gyrus, superior parietal lobule) in higher CSVD burden groups (F values ranged from 7.533 to 9.643, all P values remained statistically significant after Bonferroni correction). Notably, the highest burden group (CSVD 4) exhibited the most severe GMV loss. Concurrently, functional MRI analysis showed significantly increased ReHo values in the left thalamus and left temporal pole in high CSVD burden groups (specifically CSVD 4 > CSVD 2 and CSVD 4 > CSVD 3; all P values remained statistically significant after FDR correction). However, no significant correlations were observed between these structural or functional metrics and cognitive scores (Mini-Mental State Examination, Montreal Cognitive Assessment) after multiple comparison correction.Conclusions Our findings indicate that increased CSVD total score is accompanied by dual-pattern alterations: "thalamic-somatomotor network structural atrophy" and "active local functional compensation". These findings provide novel neuroimaging biomarkers for understanding the mechanisms of CSVD-related cognitive impairment; however, the direct correlation with cognitive performance requires further validation through larger sample sizes and longitudinal studies.
[Keywords] cerebral small vessel disease；total score；magnetic resonance imaging；structural magnetic resonance imaging；functional magnetic resonance imaging；thalamus；cognitive impairment

ZHANG Qin   WANG Jie   LI Yunfei   FENG Tianyuyi   WANG Meimei   ZHAO Xiaohu*  

Department of Radiology, the Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China

Corresponding author: ZHAO X H, E-mail: xhzhao999@263.net

Conflicts of interest   None.

Received  2025-10-27
Accepted  2026-01-08
DOI: 10.12015/issn.1674-8034.2026.02.006
DOI:10.12015/issn.1674-8034.2026.02.006.

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