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Updated: May 20, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Cerebral microbleed detection and mapping: principles, methodological aspects and rationale in vascular dementia
Andreas Charidimou1, Hans R Jäger, David J Werring
1Stroke Research Group, Department of Brain Repair and Rehabilitation, The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
Abstract:
Cerebral microbleeds (CMBs) have emerged as an important new imaging manifestation of sporadic cerebral small vessel diseases - mainly hypertensive arteriopathy and cerebral amyloid angiopathy - which are highly prevalent in the elderly and have a critical role in vascular cognitive impairment and dementia. With the development of MRI techniques that are exquisitely sensitive to the products of bleeding, including T2*-weighted gradient-recalled echo (T2*-GRE) and susceptibility-weighted imaging (SWI), CMBs have been detected in ever-increasing numbers of patients, including those with vascular cognitive impairment and dementia, as well as in population-based samples of healthy elderly people. Our increased ability to image CMBs and hence to see the development and progression of cerebral small vessel disease raises many clinical and pathophysiological questions about the mechanisms, diagnosis and monitoring of cognitive impairment. In order to tackle these questions, it is important to be able to reliably detect, define and map CMBs in the brains of elderly people. In this review, we consider radiological detection methods, criteria for defining CMBs (including a practical approach to the identification of CMB "mimics"), and the use of standardised rating scales. We also briefly discuss the potential for automatically detecting and quantitatively mapping CMBs in future.
Insights
Cerebral microbleeds (CMBs) are increasingly detected in elderly individuals using advanced MRI. Reliable detection and mapping of CMBs are crucial for understanding their role in cognitive impairment and small vessel diseases.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Cerebral microbleeds (CMBs) are key imaging markers of cerebral small vessel diseases, particularly hypertensive arteriopathy and cerebral amyloid angiopathy.
- These conditions are common in the elderly and significantly contribute to vascular cognitive impairment and dementia.
- Advanced MRI techniques like T2*-GRE and SWI enhance CMB detection, revealing their prevalence in both patient and healthy elderly populations.
Purpose of the Study:
- To address clinical and pathophysiological questions regarding the mechanisms, diagnosis, and monitoring of cognitive impairment related to CMBs.
- To emphasize the importance of reliable detection, definition, and mapping of CMBs in the aging brain.
- To review current methodologies for CMB identification and discuss future automated approaches.
Main Methods:
- Review of radiological detection methods for cerebral microbleeds.
- Discussion of criteria for defining CMBs, including identification of mimics.
- Consideration of standardized rating scales for CMB assessment.
Main Results:
- CMBs are increasingly detected in elderly populations, including those with cognitive impairment and healthy individuals.
- Advanced MRI techniques have significantly improved the ability to visualize CMBs.
- The review consolidates approaches to CMB detection and definition.
Conclusions:
- Reliable detection and mapping of CMBs are essential for understanding their impact on cognitive function and small vessel diseases.
- Standardized methods and future automated tools are needed for accurate CMB assessment.
- Further research is warranted to elucidate the full clinical significance of CMBs in aging.
