51 patients with cerebral microangiopathy were studied with MRI, 18FDG-PET, and 99mTc-HMPAO-SPECT. Exact morphological correlation of MRI-findings to functional data from PET and SPECT was obtained by a special head holder system applied to the patient's head. Patients with less than four lacunar infarctions (LI) and without or only slight deep white matter lesions (DWML) in MRI showed no significantly changed parameters (rMRGlu, rCBF) compared to patients with four or more LI and severe DWML. Patients with medium to severe outer and inner brain atrophy showed significantly lower rMRGlu and rCBF values in both cortex and white matter than patients with no to only slight atrophy. Thus, in patients with cerebral microangiopathy only atrophy and not the presence of LI and DWML is associated with a significant reduction of rCBF and rMRGlu.