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Published on: April 14, 2014
White Matter Lesion Assessment in Patients with Cognitive Impairment and Healthy Controls: Reliability Comparisons
Erik Olsson1, Niklas Klasson, Josef Berge
1Department of Neuroscience and Physiology, Institute of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.
Abstract:
Age-related white matter lesions (WML) are a risk factor for stroke, cognitive decline, and dementia. Different requirements are imposed on methods for the assessment of WML in clinical settings and for research purposes, but reliability analysis is of major importance. In this study, WML assessment with three different methods was evaluated. In the Gothenburg mild cognitive impairment study, MRI scans from 152 participants were used to assess WML with the Fazekas visual rating scale on T2 images, a manual volumetric method on FLAIR images, and FreeSurfer volumetry on T1 images. Reliability was acceptable for all three methods. For low WML volumes (2/3 of the patients), reliability was overall lower and nonsignificant for the manual volumetric method. Unreliability in the assessment of patients with low WML with manual volumetry may mainly be due to intensity variation in the FLAIR sequence used; hence, intensity standardization and normalization methods must be used for more accurate assessments. The FreeSurfer segmentations resulted in smaller WML volumes than the volumes acquired with the manual method and showed deviations from visible hypointensities in the T1 images, which quite likely reduces validity.
Insights
Assessing white matter lesions (WML) is crucial for understanding cognitive decline. While three MRI methods showed acceptable reliability, manual volumetry struggled with low WML volumes, suggesting a need for improved standardization.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Age-related white matter lesions (WML) are significant risk factors for stroke, cognitive decline, and dementia.
- Reliable assessment of WML is critical for both clinical practice and research.
- Existing WML assessment methods require rigorous reliability analysis.
Purpose of the Study:
- To evaluate and compare the reliability of three different methods for assessing white matter lesions (WML).
- To identify potential limitations of current WML assessment techniques, particularly in cases with low lesion burden.
Main Methods:
- Utilized MRI scans from 152 participants in the Gothenburg mild cognitive impairment study.
- Assessed WML using the Fazekas visual rating scale on T2 images.
- Employed a manual volumetric method on FLAIR images and FreeSurfer volumetry on T1 images.
Main Results:
- All three WML assessment methods demonstrated acceptable reliability overall.
- The manual volumetric method showed lower and nonsignificant reliability for patients with low WML volumes.
- FreeSurfer volumetry yielded smaller WML volumes than manual methods and exhibited deviations from visible hypointensities, potentially impacting validity.
Conclusions:
- While generally reliable, manual WML volumetry requires intensity standardization for accurate assessment, especially in low-lesion-volume cases.
- Intensity variations in FLAIR sequences may contribute to unreliability in manual WML assessment.
- FreeSurfer's accuracy in WML volume estimation warrants further investigation regarding its validity.
