Magnetic Resonance Imaging of Perivascular Spaces in the Human Brain During a Small Vessel Stroke

Perivascular spaces (PVS) are fluid-filled spaces around the brain blood vessels involved in fluid drainage.

To examine alterations in PVS during a small vessel stroke, perform magnetic resonance imaging (MRI) of the basal ganglia region in the patient’s brain.

The imaging protocol includes the T2-weighted fast spin echo and fluid-attenuated inversion recovery (FLAIR) sequences.

T2-weighted imaging enhances the contrast between cerebrospinal fluid (CSF)-filled PVS and surrounding tissue.

FLAIR suppresses the CSF signal, enabling the differentiation of PVS from old lacunar infarcts.

Ensure appropriate imaging parameters for high-resolution imaging.

Identify PVS as round, oval, or linear structures with signal intensity similar to CSF on T2-weighted images.

On FLAIR, PVS appears hypointense, lacking the hyperintense rim seen in old lacunar infarcts.

Visually grade the PVS on the MRI slice that shows the highest concentration of PVS in one hemisphere to assess their severity.