Small vessel disease (SVD) is associated with elevated vascular stiffness and pulsatility, but longitudinal studies are lacking. Using a 4D flow MRI approach sensitive to age-differences in pulsatility in large and small cerebral arteries, we evaluated 5-year changes in pulsatility in relation to changes in white matter lesions (WML) and perivascular spaces (PVS), radiological markers of SVD. Pulsatility change correlated with WML and PVS volume change, but pulsatility at baseline did not predict WML and PVS progression. However, WML and PVS volumes at baseline predicted 5-year pulsatility change, suggesting that microvascular dysfunction associated with SVD accelerates pulsatility increases.
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