PURPOSE: To evaluate the relationship of signal void dots seen on T2-weighted images with hypertension,hypertensive intracerebral hemorrhage and infarction. MATERIALS AND METHODS: MR images of 73 consecutive patientswith signal void dots on T2-weighted images were reviewed. Seventy-three randomly selected age-matched patientswithout signal void dot lesion were also reviewed. We evaluated 1) the location and number of signal void dots; 2)the frequency of hypertension among patients and controls; 3) the frequency of associated brain parenchymalabnormalities (hypertensive intracerebral hemorrhage, microangiopathy and infarction) in both groups; 4) therelationship between the number of signal void dots and associated brain lesions in the patient group. RESULTS: Signal void dots numbered 1-50(average, 12), and were found mostly in the thalamus, basal ganglia, and the pons.Hypertension(97.1%), hypertensive ICH(43.8%) and microangiopathy(96%) were frequent in patients with signal voiddots, the number of which correlated with the severity of microangiopathy. Infarction(13.7%), however, did notcorrelate with dots. CONCLUSION: Signal void dots correlate closely with hypertension, hypertensive ICH, andmicroangiopathy. They may indicate hypertensive brain change.