What are the findings of Microvascular Ischemic Disease on Magnetic Resonance Imaging (MRI)?

From the Guidelines

Microvascular ischemic disease on MRI should be managed by controlling risk factors such as hypertension, diabetes, smoking, and high cholesterol to prevent progression, as recommended by the most recent guidelines 1. The condition is characterized by small areas of brain damage caused by reduced blood flow through the smallest blood vessels in the brain, appearing as small white spots or lesions on MRI scans, particularly in T2-weighted or FLAIR sequences. Key management strategies include:

• Maintaining blood pressure below 130/80 mmHg through medications like ACE inhibitors, ARBs, or calcium channel blockers
• Controlling blood sugar in diabetic patients
• Statin therapy to maintain LDL cholesterol below 100 mg/dL
• Daily aspirin (81-325 mg) to reduce stroke risk
• Lifestyle modifications such as smoking cessation, regular exercise, maintaining a healthy weight, limiting alcohol consumption, and following a Mediterranean or DASH diet. Regular follow-up with a healthcare provider is crucial to monitor the condition and adjust treatment as needed, as microvascular ischemic changes can increase the risk of cognitive decline, gait problems, and stroke if extensive or progressive 1. The use of MRI with diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), susceptibility scans, T1-weighted and T2-weighted scans is recommended for assessing microvascular ischemic disease, as it provides more sensitive and detailed information compared to CT scans 1.

From the Research

Microvascular Ischemic Disease on MRI

• Microvascular ischemic disease can be evaluated using cardiac magnetic resonance imaging (MRI) 2
• Cardiac MRI is useful for evaluating microvascular obstruction and ischemia in patients with ischemic heart disease 2
• The main prognostic factors in cardiac MRI are ventricular dysfunction, necrosis in late enhancement sequences, and ischemia in stress sequences 2

Pathophysiology and Classification

• Microvascular disease of the heart and brain have similar pathophysiological mechanisms and can be evaluated using MRI 3
• Coronary microvascular disease and cerebral small vessel disease are two types of microvascular disease that can cause significant morbidity and mortality 3
• The pathogenesis of coronary microvascular dysfunction is complex and involves functional and structural alterations leading to impaired coronary blood flow and resulting in myocardial ischemia 4

Diagnostic Modalities

• MRI can be used to evaluate microvascular disease of the heart and brain, including coronary microvascular disease and cerebral small vessel disease 3
• Novel approaches for streamlined imaging of the cardiac and central nervous systems, including the use of intravascular contrast agents such as ferumoxytol, are being developed 3
• Cardiac MRI can detect ischemia induced by pharmacological stress and diagnose infarcts that can be missed on other techniques 2