Scientific article
OA Policy
English

Advanced neuroimaging of vascular cognitive impairment and dementia : biomarkers, guidelines, and clinical impact

Published inBritish journal of radiology, tqag182
First online date2026-08-07
Abstract

Vascular cognitive impairment and dementia (VCID) is a leading modifiable contributor to dementia, accounting for an estimated 27-33% of attributable dementia cases. Neuroimaging is central to detection, phenotyping, and longitudinal monitoring. This neuroradiology-focused review integrates the STRIVE-2 imaging lexicon with the VasCog-2 clinical framework and reviews the advanced MRI techniques most pertinent to VCID, spanning clinically established to emerging research approaches: arterial spin labelling, diffusion tensor imaging including peak width of skeletonised mean diffusivity (PSMD), quantitative susceptibility mapping, vessel architecture imaging, and resting-state functional MRI. Unlike previous reviews, we consolidate operational quantitative thresholds already informing decisions (the Staals total small-vessel-disease score, longitudinal white matter hyperintensity progression linked to dementia risk, microbleed and cortical superficial siderosis (cSS) criteria for anti-amyloid therapy eligibility, and validated PSMD reference ranges) and we critically address gaps between research-grade acquisitions and routine clinical workflows. Automated segmentation and structured reporting are transitioning into deployment, expanding the radiologist's role to combine pattern recognition with quantitative characterisation. We outline current limitations of standardisation, reproducibility, and external validation that remain prerequisites before quantitative VCID imaging achieves formal regulatory biomarker qualification.

Keywords
  • MRI
  • VCID
  • Diffusion
  • Guidelines
  • Perfusion
  • Quantitative imaging
  • Radiomics
  • Susceptibility
  • Vascular cognitive impairment and dementia
Citation (ISO format)
OJEDA ESPARZA, Jose Federico et al. Advanced neuroimaging of vascular cognitive impairment and dementia : biomarkers, guidelines, and clinical impact. In: British journal of radiology, 2026, p. tqag182. doi: 10.1093/bjr/tqag182
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Journal ISSN0007-1285
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Technical informations

Creation19/08/2026 10:11:50
First validation28/08/2026 07:39:40
Update28/08/2026 07:54:28
Status update28/08/2026 07:54:28
Last indexation28/08/2026 07:54:30
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