Validation of a simple and reliable visual rating scale of white matter hyperintensity comparable with computer‐based volumetric analysis

Abstract

White matter hyperintensity (WMH), which is detected as hyperintense signals on T2-weighted images of brain magnetic resonance imaging (MRI), is a common finding in the aging brain. WMH is associated with various geriatric conditions, 1 and regional WMH has specific effects on cognitive impairment, gait and lower urinary tract symptoms.2-4 To measure WMH, visual rating and volumetric analysis using a computer program have been used. Volumetric measurement of WMH is more sensitive and accurate than visual rating, although the former requires specific laboratory instruments to analyze WMH. Visual rating is timeconsuming, and the results often vary among raters. Because physicians have to evaluate longitudinal changes in WMH in patients during a limited consultation time, an easier and more reliable method of visual assessment is required. WMH can be divided into two parts; periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH). Previous studies suggested that PVH and DWMH largely share common pathological characteristics.5 Automatic segmentation of WMH mostly recognized DWMH in continuity with PVH, and therefore the volume of DWMH is much smaller.4 Thus, we hypothesized that semiquantitative analysis of PVH could predict total WMH volume. The purpose of the present study was to validate the accuracy of our newly developed visual rating scale for global and regional analysis of WMH. Comparison with conventional methods was carried out by referencing computational volumetric analysis.The participants were 460 patients (318 women) aged 65-85 years; 69 diagnosed with amnestic mild cognitive impairment and 391 with Alzheimer's disease. Clinical data were obtained from the Biobank of National Center for Geriatrics and Gerontology, which collects clinical data for research. All participants underwent brain MRI. The protocol of brain MRI is described elsewhere. 4 WMH on brain MRI was evaluated by both visual and computational volumetric analysis. For visual rating, we used the Fazekas scale, 6 a scale used in the Rotterdam scan study (Rotterdam scale) 7 and our new scale, which is a modified version of the Rotterdam scale (modified Rotterdam scale).2,3 The Fazekas scale is a simple classification of PVH (grade 0-3), whereas the Rotterdam scale and modified Rotterdam scale are semiquantitative methods. PVH in the Rotterdam scale is visually rated into four grades at frontal caps, bands and occipital caps. The total score was calculated by adding the three region-specific scores.7 In contrast, the modified Rotterdam scale rates PVH as five grades with definitive ranges of WMH dimension from the edge of ventricles at the identical regions of PVH, but separately in the left and right hemisphere. The degree of PVH was calculated by adding up the scores of six separate regions.

Frontal White Matter Hyperintensity Is Associated with Verbal Aggressiveness in Elderly Women with Alzheimer Disease and Amnestic Mild Cognitive Impairment

“…Regional distribution of WMH exhibited a high prevalence in the frontal (9.5 ± 9.6 mL) and parietal lobes (5.8 ± 7.0 mL) compared to other regions. Because automatic segmentation recognizes WMH as 3-D continuity in each MR imaging slice [ 32 ], most WMH was recognized as PVH (16.0 ± 17.3 mL), and there was markedly less DWMH (1.0 ± 1.3 mL).…”

“…Frontal regions have abundant connections with major projecting fibers, including the integration of limbic and emotional information into behavioral responses [ 40 ]. The participants in the current study exhibited relatively moderate to severe WMH volume (17.0 mL, 1.28% of IC volume), corresponding to grade 2–3 on the Fazekas scale [ 32 ]. In addition, most of the observed WMH was distributed in the periventricular region.…”

“…Brain tissue was classified as frontal, temporal, occipital, and parietal lobes, and WMH was separated into periventricular hyperintensity (PVH) and deep WMH (DWMH). Because automatic segmentation of WMH mostly recognized DWMH in continuity with PVH, the distinction was manually classified [ 32 ]. Global brain atrophy was assessed by parenchyma, which is the subtraction of cerebrospinal fluid from intracranial (IC) volume, corresponding to the sum of total gray and white matter volumes.…”

The Association Between Coronary Artery Calcification and Subclinical Cerebrovascular Diseases in Men: An Observational Study

“…Second, our study results apply only to men as we did not include women. Third, we used visual grading for white matter hyperintensity, whereas volumetric measurements may be more accurate and sensitive 30) . Fourth, we may have underestimated the relationship between CAC and SCVDs because older and more risk-factor-clustered participants were excluded from our analyses.…”

Postprandial Hyperglycemia Is Associated With White Matter Hyperintensity and Brain Atrophy in Older Patients With Type 2 Diabetes Mellitus

“…The association between postprandial hyperglycemia and frontal WMH was observed only in AD. In the current study, patients with AD had a larger global WMH volume, which corresponded to grade 2–3 on the Fazekas scale, than patients with NC, whose WMH volume corresponded to grade 1 ( Ogama et al, 2015 ). WMH volume increased markedly with aging, particularly in the frontal lobe in patients aged 75 years and over who were in the AD/aMCI cohort ( Ogama et al, 2016 ).…”