Background <p>Detection rate of chronic cerebral very small cortical infarctions (VSCI) is low. Few data are available on chronic cerebellar VSCI. Our aim was to study the ability of 1.5T FLAIR and T2-weighted imaging to detect chronic VSCI and compare cerebral and cerebellar VSCI location.</p> Methods <p>We prospectively included stroke patients with ≥ 1 acute cerebral or cerebellar VSCI ≤ 10&#xa0;mm on DWI. Follow-up FLAIR and T2-weighted imaging with the same 1.5T-magnet was performed after six months. Images were evaluated unblinded to initial MRI to detect signal changes at the same location as initial acute VSCI. Variables influencing chronic VSCI detection were analyzed in uni- and multivariate analyses.</p> Results <p>We analyzed 57 patients (median age 65, 44% women) with 111 acute VSCI on initial MRI. These constituted 47 cerebellar and 64 cerebral acute VSCI, with median DWI size of 5.9&#xa0;mm and initial FLAIR positivity of 70%, without difference between cerebellar and cerebral location. On 6-month follow-up MRI, chronic VSCI detection on FLAIR and T2 was similar for cerebral lesions (<i>p</i> = 0.81), whereas for cerebellar lesions T2 showed a 2.4-fold higher detection rate than FLAIR (<i>p</i> &lt; 0.0001). Univariate analysis using a logistic mixed model for T2 detection of chronic VSCI was associated with cerebellar VSCI location (<i>p</i> &lt; 0.0001) and hypertension history (<i>p</i> = 0.008). Multivariate analysis confirmed the strong association between cerebellar location and T2 detection of chronic VSCI (<i>p</i> &lt; 0.0001, AOR = 7.25, 95% CI = 2.83–18.56) adjusted for hypertension.</p> Conclusion <p>Compared to FLAIR, T2-weighted imaging shows highest detection rates for cerebellar VSCI, with cerebellar VSCI location as strongest predictor of chronic VSCI detection.</p> Clinical trial registration <p>URL http//www.clinicaltrials.gov. Unique identifier NCT06218576.</p>