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Updated: Sep 22, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Cerebral microbleeds: from depiction to interpretation
Laurent Puy1, Marco Pasi1, Mark Rodrigues2
1Department of Neurology, U1172 - LilNCog - Lille Neuroscience & Cognition, Univ. Lille, Inserm, CHU Lille, F-59000 Lille, France.
Abstract:
Cerebral microbleeds (CMBs) are defined as hypointense foci visible on T2*-weighted and susceptible-weighted MRI sequences. CMBs are increasingly recognised with the widespread use of MRI in healthy individuals as well as in the context of cerebrovascular disease or dementia. They can also be encountered in major critical medical conditions such as in patients requiring extracorporeal mechanical oxygenation. The advent of MRI-guided postmortem neuropathological examinations confirmed that, in the context of cerebrovascular disease, the vast majority of CMBs correspond to recent or old microhaemorrhages. Detection of CMBs is highly influenced by MRI parameters, in particular field strength, postprocessing methods used to enhance T2* contrast and three dimensional sequences. Despite recent progress, harmonising imaging parameters across research studies remains necessary to improve cross-study comparisons. CMBs are helpful markers to identify the nature and the severity of the underlying chronic small vessel disease. In daily clinical practice, presence and numbers of CMBs often trigger uncertainty for clinicians especially when antithrombotic treatments and acute reperfusion therapies are discussed. In the present review, we discuss those clinical dilemmas and address the value of CMBs as diagnostic and prognostic markers for future vascular events.
Insights
Cerebral microbleeds (CMBs) on MRI indicate microhaemorrhages, aiding in assessing small vessel disease severity. Harmonizing MRI techniques is crucial for reliable detection and clinical decision-making regarding vascular events.
Area of Science:
- Neuroradiology
- Neuropathology
- Vascular Neurology
Background:
- Cerebral microbleeds (CMBs) are MRI-detected hypointensities, increasingly found in healthy individuals and those with cerebrovascular disease or dementia.
- Postmortem neuropathology confirms CMBs often represent microhaemorrhages, particularly in cerebrovascular disease contexts.
- CMBs are also observed in critical conditions, including patients on extracorporeal mechanical oxygenation.
Purpose of the Study:
- To review the diagnostic and prognostic value of cerebral microbleeds (CMBs).
- To discuss clinical dilemmas associated with CMB detection, especially concerning antithrombotic and reperfusion therapies.
- To highlight the need for harmonized MRI parameters for improved cross-study comparisons.
Main Methods:
- Review of MRI findings, focusing on T2*-weighted and susceptible-weighted sequences.
- Integration of MRI-guided postmortem neuropathological examination data.
- Analysis of clinical implications and diagnostic/prognostic utility of CMBs.
Main Results:
- CMB detection is sensitive to MRI field strength, postprocessing, and sequence types.
- Harmonization of imaging parameters is necessary for reliable cross-study comparisons.
- CMBs serve as valuable markers for small vessel disease nature and severity.
Conclusions:
- Cerebral microbleeds are significant indicators of underlying cerebrovascular pathology.
- Standardizing MRI acquisition and analysis is essential for consistent CMB assessment.
- CMBs hold potential as diagnostic and prognostic markers for future vascular events.
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