Volumetric White Matter Hyperintensity Ranges Correspond to Fazekas Scores on Brain MRI
Ariana Andere1, Gaurav Jindal2, Janine Molino3
1Department of Neurology, Brown University, Providence, RI, United States.
Introduction:
White matter hyperintensity (WMH) is an abnormal T2 signal in the deep and subcortical white matter visualized on MRI associated with hypertension, cerebrovascular disease, and aging. The Fazekas (Fz) scoring system is a commonly used qualitative tool to assess the severity of WMH. While studies have compared Fazekas scores to other scoring methods, the comparison of Fazekas scores and volume of WMH using current semiautomated volumetric techniques has not been studied.
Methods:
We reviewed MRI studies acquired at our institution between 2015 and 2017. Relative WMH was scored by one author trained in Fazekas scoring. A board certified neuroradiologist scored them independently for confirmation. Manual segmentations of WMH were completed using 3D Slicer 4.9. A 3D model was formed to quantify WMH in milliliters (mL). ANOVA tests were performed to determine the association of Fazekas scores with corresponding WMH volumes.
Results:
Among the 198 patients in our study, WMH were visualized in 163 (Fz1: n=66; Fz2: n=49; Fz3: n=48). WMH volumes significantly differed according to Fazekas score (F = 141.1, p<0.001), with increasing WMHV associated with higher Fazekas scores: Fz1, range 0.1-8.3 mL (mean 3.7, SD 2.3); Fz2, range 6.0-17.7 mL (mean 10.8, SD 3.1); Fz3, range 14.2-77.2 mL (mean 35.2, SD 17.9); and Fz3 (excluding 11 outliers above 50 mL), 14.2-47.0 mL (mean 27.1, SD 8.9).
Conclusion:
Fazekas scores correspond with distinct ranges of WMH volume with relatively little overlap, but scores based on volumes are more efficacious. A modified Fazekas from 0-4 should be considered.
Insights
White matter hyperintensity (WMH) Fazekas scores correlate with WMH volume. Quantitative volumetric analysis offers more precise assessment than qualitative scoring for these MRI findings.
Area of Science:
- Neuroimaging
- Radiology
- Cerebrovascular Disease
Background:
- White matter hyperintensity (WMH) on MRI indicates potential cerebrovascular disease and aging.
- The Fazekas (Fz) scoring system is a standard qualitative method for assessing WMH severity.
- Quantitative volumetric analysis of WMH has not been extensively compared with the Fazekas score.
Purpose of the Study:
- To compare the commonly used Fazekas scoring system with semiautomated volumetric measurements of white matter hyperintensity (WMH).
- To investigate the association between qualitative Fazekas scores and quantitative WMH volumes derived from MRI.
Main Methods:
- Retrospective review of 198 MRI studies from 2015-2017.
- Independent WMH scoring by a trained author and a board-certified neuroradiologist using the Fazekas system.
- Manual WMH segmentation and volumetric quantification using 3D Slicer 4.9, followed by ANOVA testing.
Main Results:
- WMH were present in 163 patients, categorized by Fazekas scores (Fz1, Fz2, Fz3).
- Significant differences in WMH volume (mL) were observed across Fazekas scores (F=141.1, p<0.001).
- Increasing Fazekas scores correlated with progressively larger WMH volumes, with distinct ranges for each score.
Conclusions:
- Fazekas scores align with specific WMH volume ranges, though with some overlap.
- Volumetric quantification of WMH provides a more efficacious assessment compared to qualitative scoring alone.
- Consideration of a modified Fazekas scoring system (0-4) is recommended for improved clinical utility.
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