ESOC 2026 | Perivascular spaces as imaging biomarkers for stroke and dementia risk

Yeah, so perivascular spaces are visible on brain magnetic resonance imaging as little lines or dots and they’re basically spaces around the tiny blood vessels as they run into the brain. And they’re thought to be part of the brain’s fluid clearance and waste clearance system. But they’ve been largely ignored, although we know that they’re probably part of the spectrum of small vessel disease. And part of the problem is that up until now, we’ve relied on visual scores to assess the burden of perivascular spaces. But we now have computational methods that allow us to measure things like the total volume, the total count, and get much more detailed information. And we used that to examine 70,000 subjects in UK Biobank who had had a brain MRI. And we looked at their risk of having a stroke or a diagnosis of dementia in up to 10 years after their brain MRI. And about 500 people had had a stroke out of the 70,000 who’d had the brain MRI, and about 250 had had a diagnosis of dementia in that time. And we saw that both the risk of stroke and the risk of dementia were substantially increased if you had a bigger volume of perivascular spaces or you had a higher count of perivascular spaces. So it kind of emphasizes that actually perivascular spaces are not just a sort of interesting imaging phenotype that you should ignore, but actually that they have clinical implications and that they should be incorporated into people’s assessment of brain imaging when they’re considering the individual and their future risk.

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