It is shown that low-field portable MRI systems (<0.1T) offer point-of-care acquisition with reduced infrastructure requirements and have demonstrated concordance with conventional MRI for multiple acute brain pathologies.
Abstract
Cerebral small vessel disease (SVD) is the most common age-related brain pathology. Magnetic resonance imaging (MRI) is the reference standard for identifying SVD biomarkers, including white matter hyperintensity, recent small subcortical infarcts, lacunes, perivascular spaces, cerebral microbleeds, and cortical superficial siderosis. However, SVD is usually detected only when patients undergo conventional high-field MRI, limiting early identification, longitudinal monitoring, and equitable access to brain health evaluation. Low-field portable MRI systems (<0.1T) offer point-of-care acquisition with reduced infrastructure requirements and have demonstrated concordance with conventional MRI for multiple acute brain pathologies. We review the emerging evidence for portable MRI-based detection of SVD features, with an emphasis on white matter hyperintensity. Future portable MRI work on SVD should prioritize longitudinal validation, standardized reporting, and integration into pragmatic vascular prevention trials.
Low-field and portable MRI show promising diagnostic potential for AIS and TIA, particularly when conventional MRI is unavailable, delayed, or impractical, but current evidence is limited by small, predominantly single-center studies with substantial risk of bias.
Rachana R. Borkar, Sai Dhanush Reddy Jeggari, Kamal Kandel et al.· Brain Science· 0 citations
Diffusion MRI biomarkers were abnormal at least a decade before WMH abnormality in the population, revealing a prolonged phase of early SVD and highlighting their potential for SVD prevention.
P. Vemuri, Ming-Zhao Hu, Emily S. Lundt et al.· Stroke· 0 citations
The current clinical evidence base is reviewed, including the role of LF-MRI in supporting stroke-type classification and tissue confirmation, in wake-up and unknown-onset stroke for tissue-based triage, and in post-therapeutic settings to enable serial assessment after thrombolysis or thrombectomy.
A. Sorby-Adams, N. Pintér, Keith W. Muir et al.· Stroke· 0 citations
Inroduction Cerebral small vessel disease contributes substantially to cognitive decline in older adults, but conventional structural magnetic resonance imaging markers mainly reflect accumulated lesion burden and do not directly characterize diffusion-derived alterations in brain fluid homeostasis. We investigated whether combining diffusion imaging along the perivascular space and white matter free-water imaging improves identification of Montreal Cognitive Assessment (MoCA)-defined cognitive impairment in elderly patients with cerebral small vessel disease. Methods This prospective study included 100 patients with cerebral small vessel disease and 50 healthy controls. According to MoCA scores, patients were classified as cognitively normal (n = 42) or cognitively impaired (n = 58). All participants underwent 3.0-T magnetic resonance imaging, including conventional structural imaging and diffusion tensor imaging. Conventional structural magnetic resonance imaging markers were evaluated on anatomical imaging, whereas diffusion-derived metrics were used to assess perivascular diffusion and free-water burden. Group comparisons, correlation analyses, multivariate logistic regression, and receiver operating characteristic analyses were performed. Results Analysis along the perivascular space decreased progressively from healthy controls to cognitively normal patients and cognitively impaired patients, whereas white matter free water increased in the opposite direction (all p < 0.001). Lower ALPS-Index values and higher white matter free-water values were both associated with lower MoCA scores. The clinical information model showed moderate discrimination for MoCA-defined cognitive impairment (area under the curve = 0.764, 95% confidence interval: 0.669–0.859). After incorporating age, sex, education, hypertension, and diabetes as covariates, the traditional cerebral small vessel disease marker model achieved an area under the curve of 0.819 (95% confidence interval: 0.731–0.908), whereas the glymphatic-edema signature combining ALPS-Index and white matter free water achieved better discriminative performance (area under the curve = 0.928, 95% confidence interval: 0.875–0.981). The combined imaging model incorporating conventional structural markers, ALPS-Index, and white matter free water achieved the highest discriminative performance (area under the curve = 0.950, 95% confidence interval: 0.906–0.993). Discussion Perivascular diffusion imaging and white matter free water capture complementary aspects of altered perivascular diffusion and extracellular free-water accumulation in cerebral small vessel disease and improve identification of MoCA-defined cognitive impairment beyond conventional structural magnetic resonance imaging markers.
Chunhong Yang, Sunmei Cai, Bingbing Wang et al.· Frontiers in Neurology· 0 citations
Low-field magnetic resonance imaging (LF-MRI) has recently emerged as a novel approach to extend MRI capability into critical care environments and offers a unique opportunity to support repeated imaging during periods when neurological examination is unreliable or limited.
Lina Zheng, Z. Law, X. Nie et al.· Stroke· 0 citations
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.
Jose Federico Ojeda-Esparza, D. Botta, A. Fitsiori et al.· British Journal of Radiology· 0 citations
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