Probabilistic maps of white matter hyperintensity in a Chinese aging cohort and application for clinical diagnosis

White matter hyperintensities (WMH) are abnormalities in brain imaging that contribute to cognitive decline and diseases. This study aimed to build WMH probability maps (WPMs) and normative data of WMH volume from a Chinese aging cohort, to offer valuable insights for diagnosis.

We developed WPMs from a comprehensive dataset across six age groups (20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years), encompassing 735 participants. WMH segmentation was performed with a deep learning approach, and the resulting masks were registered to the standard space for WPM construction. We explored how WMH volume changed with age and established normative data for different age groups. Additionally, we examined whether WMH volume moderates the relationship between aging and cognitive decline. The practical utility of WPMs was then validated with a separate patient cohort with mild cognitive impairment and Alzheimer's disease.

WPMs and the normative data of WMH volume were constructed for six age groups. As age increased, both the likelihood and spatial coverage of WMH grew. All types of WMH (total, periventricular, and deep white matter hyperintensities) quadratically increased with age. Deep white matter hyperintensities moderated the decline of general cognitive abilities related to aging. The two patient groups had significantly higher ratios of abnormal WMH than typical aging adults.

We successfully built WPMs and WMH normative data for Chinese adults and demonstrated their clinical diagnostic values.

Question Current diagnostic tools lack population-specific references for white matter hyperintensities (WMH)in Chinese aging adults, limiting accurate discrimination between pathological neurodegeneration and typical aging patterns. Findings These Chinese WMH probability maps show quadratic age-related growth, with deep WMH moderating cognitive decline. Mild cognitive impairment/Alzheimer's Disease (MCI/AD) patients exhibited significantly higher WMH volumes. Clinical relevance These population-specific WMH references enable clinicians to quantitatively identify abnormal aging and early neurodegeneration in Chinese patients, addressing the critical need for ethnically tailored diagnostic tools in Alzheimer's disease and vascular cognitive impairment.