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Definitions of white matter hyperintensity change: impact on estimates of progression and regression
Angela C C Jochems1,2, Susana Muñoz Maniega2,3, Una Clancy1,2
1UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK.
Background:
White matter hyperintensity (WMH) progression is well documented; WMH regression is more contentious, which might reflect differences in defining WMH change. We compared four existing WMH change definitions in one population to determine the effect of definition on WMH regression.
Methods:
We recruited patients with minor non-disabling ischaemic stroke who underwent MRI 1-3 months after stroke and 1 year later. We assessed WMH volume (in absolute mL and % intracranial volume) and applied four different definitions, including two thresholds (based on SD or mL), percentile and quintile approaches.
Results:
In 198 participants, mean age 65.5 (SD=11.13), baseline WMH volume was 15.46 mL (SD=19.2), the mean net WMH volume change was 0.98 mL (SD=2.84), range -7.98 to +12.84 mL. Proportion regressing/stable/progressing WMH were threshold 1 (SD), 29.8%/55.6%/14.6%; threshold 2(mL), 29.8%/16.7%/53.5%; percentile approach, 28.3%/21.2%/50.5%. The quintile approach includes five groups with quintile 3 reflecting no change (N=40), quintiles 1 and 2 any WMH decrease (N=80) and quintiles 4 and 5 any WMH increase (N=78).
Conclusions:
Different WMH change definitions cause big differences in how participants are categorised; additionally, non-normal WMH distribution precludes use of some definitions. Consistent use of an appropriate definition would facilitate data comparisons, particularly in clinical trials of potential WMH treatments.
Insights
Different methods for measuring white matter hyperintensity (WMH) changes significantly alter study results. Standardizing WMH change definitions is crucial for consistent clinical trial data and WMH treatment research.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- White matter hyperintensity (WMH) progression is established, but regression remains debated.
- Discrepancies in defining WMH change may explain differing regression findings.
- This study compares four definitions of WMH change in a single patient cohort.
Purpose of the Study:
- To evaluate the impact of different white matter hyperintensity (WMH) change definitions on observed WMH regression.
- To determine how varying definitions affect the categorization of WMH changes in patients post-stroke.
Main Methods:
- Recruited 198 patients with minor ischemic stroke.
- Performed MRI scans 1-3 months and 1 year post-stroke.
- Assessed white matter hyperintensity (WMH) volume (mL and % ICV) using four definitions: two thresholds (SD, mL), percentile, and quintile approaches.
Main Results:
- Mean age was 65.5 years; baseline WMH volume averaged 15.46 mL.
- Net WMH volume change averaged 0.98 mL, with significant variation (-7.98 to +12.84 mL).
- Categorization varied greatly: e.g., SD threshold showed 29.8% regression, while mL threshold showed 53.5% progression.
Conclusions:
- WMH change definitions significantly impact patient categorization.
- Non-normal WMH distribution limits the applicability of certain definitions.
- Adopting a consistent, appropriate WMH change definition is vital for comparing data, especially in clinical trials for WMH treatments.
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