Small vessel disease: Meaning in a Radiology Report

Also written as: chronic microvascular ischemic changes, chronic small vessel ischemic disease, cerebral small vessel disease, microangiopathy

Small vessel disease is wear and narrowing of the brain's tiniest blood vessels. On scans it shows as patchy changes deep in the brain.

What it means

Tiny arteries run deep into the brain to feed its core. Over the years their walls can thicken and stiffen, so less blood gets through. The tissue they supply then shows small patches of damage. These include bright spots on MRI (white matter hyperintensities), small old strokes (lacunes) and sometimes tiny old bleeds. Reports may call this chronic microvascular ischemic change, where ischemic means short of blood supply.

When it matters

Mild changes are very common in older adults and often cause no symptoms. They are linked to high blood pressure, diabetes, smoking and high cholesterol. More extensive disease can add to the risk of stroke, balance problems and memory changes over time. For that reason your doctor may focus on these risk factors. Repeat scans are not usually needed unless symptoms change.

Questions to ask your doctor

Is the amount of change usual for someone my age?
Which risk factors, like blood pressure, should we work on first?
Could these changes explain symptoms like unsteadiness or forgetfulness?

General information, not medical advice. What a finding means for you depends on your symptoms, your history and the images themselves, so talk your results through with a doctor.