Stroke and Small Vessel Disease Imaging Evaluation Forms

This collection comprises a set of structured, standardised visual rating forms developed to support the visual evaluation and quantification of acute stroke lesions and cerebral small vessel disease (SVD) burden on brain MRI or CT, primarily for research use but also adaptable to clinical settings. Earlier versions informed the STRIVE-1 (Standards for Reporting Vascular Changes on Neuroimaging) criteria [1] and these current versions capture the most recent STRIVE-2 criteria [2]. Designed in, and refined through, many cross-sectional [3-5] and longitudinal [6-9] studies including clinical trials [10,11], the visual rating forms facilitate consistent data capture across multiple timepoints- diagnostic, baseline, and follow-up imaging. They include detailed fields to record scan information (e.g., date, MRI sequences completed), and systematically assess the index stroke lesion, including hemisphere, visibility, shape, cavitation (if applicable), lesion dimensions, and other characteristics. The forms also enable comprehensive assessment of chronic and incidental pathology, including old lesions or lacunes, white matter hyperintensities (graded using the Fazekas scale), enlarged perivascular spaces, cerebral microbleeds, basal ganglia iron deposition, superficial siderosis, and global or regional atrophy. Two additional appendix forms are included to document cases with multiple index lesions or to track new lesions appearing during longitudinal follow-up. These forms aim to promote reproducibility and harmonisation in neuroimaging-based stroke and SVD research, supporting structured and consistent data collection and analysis across sites and studies. They also provide a reference standard based on visual scoring from which numerous computational lesion analysis methods have been developed and against which they have been validated. References 1. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12(8): 822-38. 2. Duering M, Biessels GJ, Brodtmann A, et al. Neuroimaging standards for research into small vessel disease-advances since 2013. Lancet Neurol 2023; 22(7): 602-18. 3. Wardlaw JM, Doubal F, Armitage P, et al. Lacunar stroke is associated with diffuse blood-brain barrier dysfunction. Ann Neurol 2009; 65(2): 194-202. 4. Stringer MS, Blair GW, Kopczak A, et al. Cerebrovascular function in sporadic and genetic cerebral small vessel disease. Annals of Neurology 2025; 87(3): 483-98. 5. Staals J, Makin SDJ, Doubal F, Dennis M, Wardlaw JM. Stroke subtype, vascular risk factors and total MRI brain small vessel disease burden. Neurology 2014; 83: 1228-34. 6. Wardlaw JM, Chappell FM, Valdes Hernandez MDC, et al. White matter hyperintensity reduction and outcomes after minor stroke. Neurology 2017; 89(10): 1003-10. 7. Clancy U, Jaime Garcia D, Stringer M, et al. Rationale and design of a longitudinal study of cerebral small vessel diseases, clinical, and imaging outcomes in patients presenting with mild ischaemic stroke: Mild Stroke Study 3 (MSS-3). European Stroke Journal 2021; 6: 81-8. 8. Clancy U, Arteaga C, Jaime Garcia D, et al. Incident infarcts in patients with stroke and cerebral small vessel disease: frequency and relation to clinical outcomes. Neurology 2024; 103: e209750. 9. Hamilton OKL, Cox SR, Okely JA, et al. Cerebral Small Vessel Disease Burden and Longitudinal Cognitive Decline from age 73 to 82: the Lothian Birth Cohort 1936. Transl Psychiatry 2021; 6(11): 376. 10. Kopczak A, Stringer MS, van den Brink H, et al. Effect of blood pressure-lowering agents on microvascular function in people with small vessel diseases (TREAT-SVDs): a multicentre, open-label, randomised, crossover trial. The Lancet Neurology 2023; 22(11): 991-1004. 11. Wardlaw JM, Woodhouse LJ, Mhlanga I, et al. A Randomised Clinical Trial of Isosorbide Mononitrate and Cilostazol for Symptomatic Cerebral Small Vessel Disease: The LACunar Intervention Trial-2 (LACI-2). JAMA Neurology 2023; 80(7): 682-92.