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Quantitative Relationship Between White Matter Hyperintensity Volume and Fazekas Score on Brain MRI.
Yu-Yuan Xu1,2,3, Francesca M Chappell2,3, Maria Valdes Hernandez2,3
1China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, The University of Edinburgh, United Kingdom. (Y.-Y.X.).
The Fazekas score for white matter hyperintensities (WMH) in cerebral small vessel disease correlates exponentially with WMH volume. Conversion equations derived from this study allow bidirectional translation between Fazekas scores and WMH volume for improved research and clinical use.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- The Fazekas score is a standard visual rating scale for white matter hyperintensities (WMH) in cerebral small vessel disease.
- However, the precise volumetric equivalent for each Fazekas score grade remains unclear, limiting quantitative comparisons.
- This study addresses the need for a quantitative link between the Fazekas score and WMH volume.
Purpose of the Study:
- To quantify the relationship between Fazekas scores and WMH volume across diverse patient cohorts.
- To develop conversion equations for translating between visual Fazekas scores and quantitative WMH volumes.
- To facilitate standardized cross-study comparisons and aid clinical decision-making in cerebral small vessel disease.
Main Methods:
- Analysis of 1220 participants from four UK-based cohorts (LBC1936, MSS2, MSS3, INVESTIGATE).
- WMH burden quantified by absolute volume and normalized ratios (percentage of brain/intracranial volume).
- Linear, exponential, and log-linear models fitted to assess the relationship between Fazekas scores and WMH volume.
Main Results:
- WMH burden showed a monotonic increase with Fazekas score across all cohorts.
- Exponential models provided a better fit than linear models for the WMH volume-Fazekas score relationship.
- Transition zones between adjacent Fazekas grades varied, with distinct gaps between grades 5 and 6.
Conclusions:
- WMH burden progresses along an exponential trajectory with increasing Fazekas scores, exhibiting population-specific variations.
- Developed conversion equations enable bidirectional translation between Fazekas scores and WMH volume.
- These equations support cross-study comparisons, large-scale epidemiological research, and potentially clinical decision-making in cerebral small vessel disease.
