Abstract
Visual mental imagery, the ability to generate and manipulate internal visual experiences without direct sensory input, links perception with memory, planning, and higher cognition. In this targeted narrative review, we synthesize neuroimaging and lesion evidence on the brain basis of visual imagery, with a focus on neuroradiological correlates of the ventral and dorsal visual pathways. Unlike prior cognitive neuroscience reviews that primarily emphasize functional mechanisms, this review is neuroradiology-oriented and integrates lesion patterns and white-matter disconnection to support clinico-radiological interpretation of imagery complaints. Using a dual-stream framework, we contrast ventral occipito-temporal systems that preferentially support object imagery (appearance-based features such as form, faces/objects, and color, with texture remaining under-studied) with dorsal occipito-parietal systems that preferentially support spatial imagery (relations, transformations, and navigation). Across studies, imagery recruitment is strongly task- and stage-dependent: ventral regions are most often engaged during object-focused imagery, whereas parietal regions are prominent during spatial transformation tasks, with evidence for interaction between pathways when demands require both content and spatial operations. Structural and clinico-radiological findings indicate that imagery impairment can arise from focal posterior lesions and posterior neurodegenerative syndromes but also from network disruption affecting long-range connections that support top-down access to posterior representations. Finally, emerging work on aphantasia and hyperphantasia supports a network-level view in which imagery vividness relates to how effectively higher-order systems engage visual representations. We conclude that standardized, stream-sensitive tasks and multimodal approaches combining functional and structural imaging with lesion-based evidence are key to discovering clinically actionable biomarkers of imagery dysfunction.