Cerebral small vessel disease (CSVD) is one of the leading causes of vascular dementia and stroke, characterized by chronic damage to arterioles, capillaries, and small veins that supply the white matter and deep gray matter structures. The aim of the study was to assess the prevalence and spectrum of neuroimaging manifestations of CSVD in patients aged 45–80 years using magnetic resonance imaging (MRI). We analyzed the MRI findings of 465 patients examined between 2020 and 2025 using high-field scanners (1.5–3.0 T) in T1, T2, FLAIR, DWI, and SWI sequences. CSVD markers were assessed according to the STRIVE protocol and semi-quantitative scales including Fazekas, BALI, Klarenbeek, Scheltens, Kadam, DAA, and BFI indices, as well as characteristics of lacunar infarcts, cerebral microbleeds, and enlarged perivascular spaces.

The results demonstrated a clear age-dependent pattern of severity: in patients under 65 years, minimal or moderate leukoaraiosis (Fazekas 1–2), single lacunes, mild cortical and medial temporal atrophy, isolated enlarged perivascular spaces, and rare microbleeds predominated. In the group over 65 years, confluent leukoaraiosis (Fazekas 2–3), multiple lacunar infarcts, medial temporal, parietal, and global cortical atrophy, greater enlargement of perivascular spaces, higher BALI, BFI, and Klarenbeek scores, and a significantly greater number of microbleeds were recorded. Statistical analysis confirmed a significant increase in mean scores for all evaluated scales with age (p < 0.05), indicating the progressive, multifactorial nature of brain damage.

The findings highlight the high prevalence of CSVD in older age groups, the strong correlation between age and neuroimaging markers, and the need for early MRI screening and monitoring in middle-aged individuals with cerebrovascular risk factors. These results may serve as a basis for the development of personalized preventive and therapeutic strategies aimed at slowing CSVD progression and reducing the risk of vascular events.