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Yuyuan Yang,1 Meng Wang,1 Moxin Luan,1 Xiaoqian Song,1 Yajuan Wang,2 Lulu Xu,3 Meixiang Zhong,4 Xueping Zheng1 1Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China; 2Department of Geriatric Medicine, The Qingdao Eighth People’s Hospital, Qingdao, People’s Republic of China; 3Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 4Department of Geriatric Medicine, The Chengdu Eighth People’s Hospital, Chengdu, People’s Republic of ChinaCorrespondence: Xueping Zheng, Email simplexueping@163.comAbstract: Perivascular spaces are the fluid-filled areas surrounding small blood vessels in the brain, and they may play a role similar to lymphatic vessels in clearing metabolic waste. When their diameters exceed 1 mm, as measured by structural magnetic resonance imaging, they are classified as enlarged perivascular spaces (EPVS). Previously, EPVS were considered to be benign, but increasing evidence suggests that their existence may be associated with various clinical diseases. Here, we review recent clinical studies to understand the potential clinical implications of EPVS. We also review the anatomy and imaging characteristics of EPVS and discuss four causal hypotheses for their formation and associated risk factors. Due to differences in research methods and concerns across studies, unified conclusions are difficult to achieve. Overall, more basic high-quality research is needed to clarify the subject and provide more concrete theoretical support.Keywords: cerebral small vessels, enlarged perivascular spaces, cognitive decline, cerebral amyloid angiopathy, Parkinson’s disease, aging