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Visual Assessment of Age-Related White Matter Hyperintensities Using FLAIR Images at 3 T: Inter- and Intra-Rater
Claire Boutet1, Laure Rouffiange-Leclair, Fabien Schneider
1Department of Radiology, University Hospital of Saint-x00C9;tienne, Saint-x00C9;tienne, France.
Background:
Age-related white matter hyperintensities are frequent incidental findings on T2-weighted brain MRI, and they are evaluated in clinical practice using a visual rating scale.
Objective:
To evaluate inter- and intra-rater agreement in MRI visual evaluations of age-related white matter hyperintensities made by two radiologists with different levels of experience using a visual rating scale.
Methods:
Two radiologists of two different levels of experience separately rated age-related white matter hyperintensities in 40 consecutive 3-tesla brain MRI scans using the Fazekas and Schmidt visual rating scale. Ratings were made on axial FLAIR (fluid-attenuated inversion recovery) sequences. Two readings were made by each radiologist. Intra- and inter-rater agreement was statistically determined by using Cohen's weighted kappa analysis.
Results:
Forty patients (21 females, 19 males; mean age = 57 ± 18.43 years) were included between September and October 2011. Mean values ± SD for visual scores were as follows: periventricular hyperintensities, between 1.175 ± 0.9 and 1.375 ± 0.89; number of deep white matter hyperintensity lesions, between 1.325 ± 1.18 and 1.575 ± 1.15, and extent of deep white matter hyperintensity lesions, between 0.925 ± 0.78 and 1.1 ± 0.74. Intra- and inter-rater agreement was very good (x03BA; values, 0.85-0.91 and 0.80-0.97, respectively) for each of the three visual scale criteria, with significant correlations between ratings (r = 0.95; p < 0.0001) and readings (r = 0.91; p < 0.0001).
Conclusion:
Visual assessment of age-related white matter hyperintensities by radiologists using a visual scale on FLAIR sequence is reproducible. Differences in experience level do not influence readings. Visual scale use is thus justified in common practice.
Insights
Radiologists can reliably assess age-related white matter hyperintensities using visual scales on MRI scans. Reader experience does not impact the accuracy of these assessments, supporting the scale's use in clinical practice.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Age-related white matter hyperintensities are common findings on brain MRI.
- These hyperintensities are typically evaluated using visual rating scales in clinical settings.
Purpose of the Study:
- To assess the agreement between and within radiologists when evaluating age-related white matter hyperintensities.
- To determine if radiologist experience level affects the consistency of these evaluations.
Main Methods:
- Two radiologists with differing experience levels rated white matter hyperintensities on 40 brain MRI scans.
- The Fazekas and Schmidt visual rating scale was applied to axial FLAIR sequences.
- Inter- and intra-rater agreement was analyzed using Cohen's weighted kappa statistics.
Main Results:
- Intra-rater agreement ranged from 0.85-0.91, and inter-rater agreement ranged from 0.80-0.97.
- High correlations were found between ratings (r = 0.95) and readings (r = 0.91).
- Radiologist experience level did not significantly influence the assessment results.
Conclusions:
- Visual assessment of white matter hyperintensities using a scale on FLAIR sequences is reproducible.
- Experience level does not impact the reliability of these visual assessments.
- The use of visual scales for evaluating white matter hyperintensities is validated for clinical practice.
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