Role of T2-Weighted Magnetic Resonance Imaging in the Evaluation of Cerebral Small Vessel Disease

Introduction The aim of the study was to assess the usefulness of T2* gradient echo (T2* GRE) in magnetic resonance imaging (MRI) for the detection of cerebral microhaemorrhages, considering its high sensitivity to the magnetic susceptibility effects produced by paramagnetic substances such as haemosiderin. The relevance of MRI as a non-invasive diagnostic method free of ionising radiation was highlighted, especially in view of the limitations of computed tomography in identifying microscopic haemorrhagic lesions. Development Throughout the development, the anatomical, physiological, and pathophysiological foundations of the brain and cerebral microcirculation were described, establishing the relationship between microvascular disease and the appearance of cerebral microhaemorrhages. The role of the T2* GRE sequence in the visualisation of haemosiderin deposits, which manifested as hypointense punctiform foci smaller than 10 mm, was analysed. Likewise, the main associated aetiologies were identified, including arterial hypertension, cerebral amyloid angiopathy, haematological disorders, the use of anticoagulants and degenerative diseases. Its clinical importance was highlighted in vulnerable populations, such as paediatric patients, where pathologies such as leukaemia with hyperleukocytosis increased the risk of thrombosis and cerebral haemorrhage. Conclusion It was concluded that the GRE T2* sequence was an essential diagnostic tool for the early detection and evolutionary characterisation of cerebral microhaemorrhages. Its systematic incorporation into cerebral MRI protocols provided relevant information for clinical decision-making, improving the assessment of haemorrhagic risk and contributing to the prevention of serious neurological complications.