Objective  To investigate the correlation between brain structural-functional network characteristics and executive function impairment in patients with cerebral small vessel disease (CSVD) from a multimodal magnetic resonance imaging (MRI) perspective.

Methods  Thirty patients with CSVD treated in the Department of Neurology of the First Affiliated Hospital of Guangxi University of Chinese Medicine from June 2024 to December 2025 and 30 healthy controls (HC) were selected as the study participants. General clinical data were collected, and cognitive scales and multimodal MRI were used for assessment. The cognitive scales included the Mini-Mental State Examination (MMSE), Stroop Color-Word Interference Test B/C (Stroop B/C) and Vascular Dementia Assessment Scale-cognitive Subscale (VADAS-cog). The salience, frontoparietal and dorsal attention networks were selected as regions of interest (ROI), and functional connectivity (FC) values were extracted. The potential mediating role of FC between white matter hyperintensity (WMH) burden and executive function impairment was analyzed. Comparisons between the 2 groups were performed using the independent-samples t test, Mann-Whitney U test or χ² test. Partial correlation analysis was used to assess the correlations between FC and cognitive assessment scores. The mediating effect was tested using the Bootstrap method.

Results Compared with the HC group, the CSVD group showed reduced FC in the right superior temporal gyrus (t = 3.874, P ＜ 0.001), left opercular cortex (t = 4.820, P ＜ 0.001), right angular gyrus (t = 5.829, P ＜ 0.001), right middle frontal gyrus (t = 3.087, P = 0.004), left superior lateral occipital cortex (t = 5.494, P ＜ 0.001), right precentral gyrus (t = 6.511, P ＜ 0.001) and right superior lateral occipital cortex (t = 2.755, P = 0.008). Correlation analysis showed that the FC value of the right middle frontal gyrus in patients with CSVD was positively correlated with Stroop B (r = 0.759, P ＜ 0.001), Stroop C (r = 0.745, P ＜ 0.001), and VADAS-cog scores (r = 0.529, P = 0.005). Mediation analysis showed that the right middle frontal gyrus mediated the effects of WMH burden on VADAS-cog indirect effect = −0.017 9, 95% CI (−0.043 3, −0.000 2), Stroop B indirect effect = −0.020 8, 95% CI (−0.042 0, −0.002 5), and Stroop C indirect effect = −0.045 8, 95% CI (−0.090 1, −0.006 5), with none of the 95% CI including 0.

Conclusions  Patients with CSVD exhibit abnormal FC in executive control networks centered on the frontoparietal network, and the right middle frontal gyrus is a key mediating node linking white matter structural damage to executive dysfunction.