Putamen vascularization on high-resolution 7T MRI is associated with perfusion and cognitive performance in cerebral small vessel disease

• Putamen vessel distance mapping via high-resolution 7T ToF angiography • Higher CSVD severity predicts increased mean vessel distance in putamen • Greater vessel distance associates with prolonged arterial transit time • Right-putamen vessel distance associates with lower global cognitive performance In cerebral small vessel disease (CSVD), compromised arterial supply to the deep gray matter contributes to cognitive decline. While CSVD frequently involves lenticulostriate arteries supplying the putamen, the functional consequences of altered putaminal vascular architecture remain unclear. We hypothesized that a less homogeneous arterial network in the putamen is associated with impaired perfusion and worse cognitive performance in CSVD. We enrolled 16 CSVD patients with cerebral microbleeds and 21 age‑matched controls (mean age 71 years; 38 % female). High-resolution 7 T time‑of‑flight angiography was used to segment all visible intraputaminal vessels. For each voxel in the putamen, the distance to its nearest segmented vessel was computed to generate a vessel distance map; the mean vessel distance reflects the homogeneity of the arterial network. Putaminal perfusion was quantified via multi‑inversion time pulsed arterial spin labeling (ASL) at 3 T, and CSVD severity was scored on clinical 3 T MRI. All participants completed a comprehensive neuropsychological battery to derive a global cognition composite score. for each voxel in the putamen, the distance to its nearest artery was computed, yielding a vessel distance map (VDM) whose mean reflects vessel distribution homogeneity. Putaminal perfusion was quantified via pulsed arterial spin labeling at 3 T, and CSVD severity was scored on 3 T MRI. All participants completed a comprehensive neuropsychological battery to derive a global cognition composite score. Linear regression revealed that higher CSVD MRI scores predicted larger mean vessel distance, reflecting a sparser arterial network, in both the right (B = 0.12, β = 0.42, p = 0.010) and left putamen (B = 0.13, β = 0.43, p = 0.014). Across all participants, increased vessel distance was also associated with prolonged arterial transit time in the right (B = 0.044, β = 0.50, p = 0.009) and left putamen (B = 0.042, β = 0.49, p = 0.009). Finally, in a multivariable linear regression adjusting for demographics, vascular risk factors, and CSVD severity, greater vessel distance in the right putamen was associated with lower global cognitive performance (B = –1.26, β = –0.34, p = 0.012). This study demonstrates the impact of an impaired arterial network in the putamen on blood supply and cognitive function across the continuum of CSVD.