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This neuroradiology-focused review integrates the STRIVE-2 imaging lexicon with the VasCog-2 clinical framework and reviews the advanced MRI techniques most pertinent to VCID, spanning clinically established to emerging research approaches: arterial spin labelling, diffusion tensor imaging including peak width of skeletonized mean diffusivity (PSMD), quantitative susceptibility mapping, vessel architecture imaging, and resting-state functional MRI. Unlike previous eviews, we consolidate operational quantitative thresholds already informing decisions (the Staals total small-vessel-disease score, longitudinal white matter hyperintensity progression linked to dementia risk, microbleed and cortical superficial siderosis [cSS] criteria for anti-amyloid therapy eligibility, and validated PSMD reference ranges) and we critically address gaps between research-grade acquisitions and routine clinical workflows. Automated segmentation and structured reporting are transitioning into deployment, expanding the radiologist\u2019s role to combine pattern recognition with quantitative characterization. We outline current limitations of standardization, reproducibility, and external validation that remain prerequisites before quantitative VCID imaging achieves formal regulatory biomarker qualification.<\/jats:p>","DOI":"10.1093\/bjr\/tqag182","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T04:24:51Z","timestamp":1786163091000},"source":"Crossref","is-referenced-by-count":0,"title":["Advanced neuroimaging of vascular cognitive impairment and dementia: biomarkers, guidelines, and clinical impact"],"prefix":"10.1093","author":[{"given":"Jos\u00e9 Federico","family":"Ojeda-Esparza","sequence":"first","affiliation":[{"name":"Division of Neuroradiology, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Faculty of Medicine, University of Geneva , 1205 Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Botta","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Faculty of Medicine, University of Geneva , 1205 Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Fitsiori","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Faculty of Medicine, University of Geneva , 1205 Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Santarosa","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Geneva University Hospitals, 1205 Geneva, Switzerland"},{"name":"Faculty of Medicine, University of Geneva , 1205 Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Battistini","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Geneva University Hospitals, 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