Cerebral microbleeds (CMB) are increasingly recognized neuroimaging findings associated with cerebrovascular disease, dementia, and normal aging. Recent advancements in MRI techniques have improved the detection and interpretation of CMB, particularly in population-based elderly samples. The prevalence of CMB varies with MRI characteristics such as pulse sequence, sequence parameters, spatial resolution, magnetic field strength, and post-processing. T2*-weighted gradient-recalled echo (GRE) MRI is highly sensitive to susceptibility effects, making it more effective than T2-weighted spin-echo (SE) sequences in detecting CMB. Higher spatial resolution and increased magnetic field strength also enhance the detection of CMB. Image post-processing techniques, such as susceptibility-weighted imaging (SWI), further improve the contrast between brain tissue and hemosiderin deposits. The criteria for identifying CMB include signal voids on T2*-weighted MRI, round or ovoid shape, blooming effect, absence of T1- or T2-weighted hyperintensity, and at least half surrounded by brain parenchyma. CMB mimics, such as calcifications and iron deposits, can be distinguished by their appearance and clinical history. Radiological-pathological correlation studies have linked most signal voids on T2*-weighted MRI to microscopic hemorrhagic foci, suggesting that MRI may be a more sensitive method for CMB detection than histopathology. CMB can be interpreted as markers of underlying vascular pathology, such as hypertensive vasculopathy and cerebral amyloid angiopathy (CAA). They are also associated with risk factors for intracerebral hemorrhage, including hypertension, age, and low serum cholesterol concentration. CMB may predict future risk of symptomatic intracerebral hemorrhage, and their presence can influence the decision to use anticoagulation or antiplatelet therapy. Additionally, CMB may contribute to neurologic dysfunction, cognitive impairment, and disability, possibly through direct effects on brain function. The authors recommend careful consideration of MRI parameters and post-processing techniques to optimize the detection and interpretation of CMB. Future studies should focus on the anatomical distribution of CMB and their association with specific vascular pathologies to better understand their role in cerebrovascular disease.Cerebral microbleeds (CMB) are increasingly recognized neuroimaging findings associated with cerebrovascular disease, dementia, and normal aging. Recent advancements in MRI techniques have improved the detection and interpretation of CMB, particularly in population-based elderly samples. The prevalence of CMB varies with MRI characteristics such as pulse sequence, sequence parameters, spatial resolution, magnetic field strength, and post-processing. T2*-weighted gradient-recalled echo (GRE) MRI is highly sensitive to susceptibility effects, making it more effective than T2-weighted spin-echo (SE) sequences in detecting CMB. Higher spatial resolution and increased magnetic field strength also enhance the detection of CMB. Image post-processing techniques, such as susceptibility-weighted imaging (SWI), further improve the contrast between brain tissue and hemosiderin deposits. The criteria for identifying CMB include signal voids on T2*-weighted MRI, round or ovoid shape, blooming effect, absence of T1- or T2-weighted hyperintensity, and at least half surrounded by brain parenchyma. CMB mimics, such as calcifications and iron deposits, can be distinguished by their appearance and clinical history. Radiological-pathological correlation studies have linked most signal voids on T2*-weighted MRI to microscopic hemorrhagic foci, suggesting that MRI may be a more sensitive method for CMB detection than histopathology. CMB can be interpreted as markers of underlying vascular pathology, such as hypertensive vasculopathy and cerebral amyloid angiopathy (CAA). They are also associated with risk factors for intracerebral hemorrhage, including hypertension, age, and low serum cholesterol concentration. CMB may predict future risk of symptomatic intracerebral hemorrhage, and their presence can influence the decision to use anticoagulation or antiplatelet therapy. Additionally, CMB may contribute to neurologic dysfunction, cognitive impairment, and disability, possibly through direct effects on brain function. The authors recommend careful consideration of MRI parameters and post-processing techniques to optimize the detection and interpretation of CMB. Future studies should focus on the anatomical distribution of CMB and their association with specific vascular pathologies to better understand their role in cerebrovascular disease.