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Variable agreement between visual rating scales for white matter hyperintensities on MRI. Comparison of 13 rating
R Mäntylä1, T Erkinjuntti, O Salonen
1Department of Radiology, University of Helsinki, Finland. riitta.mantyla@helsinki.fi
Background And Purpose:
Previous reports on the frequency, extent, and clinical correlates of white matter hyperintensities (WMHIs) have been contradictory. The purpose of this study was to test whether part of this variation could be explained by the different properties of the visual WMHI rating scales used.
Methods:
The periventricular (PVHIs) and deep white matter (DWMHIs) hyperintensities of 395 poststroke patients were systematically analyzed and transformed to correspond to 13 different rating scales. The scales were compared with the use of Goodman-Kruskal measures of association. The relative frequencies, means, and medians of PVHI and DWMHI grades as well as Spearman rank correlations between WMHI grade and hypertension were calculated.
Results:
At best more than 80% of the patients received an equivalent WMHI grade by different scales, but at worst the corresponding values were only 0.4% for PVHI and 18% for DWMHI. At best different scales categorized patients similarly in regard to WMHI grade, but at worst the corresponding values were 8% for PVHI and 57% for DWMHI ratings. The distribution of WMHI grades also varied, and when the effect of age on WMHI was assessed, some of the scales had a ceiling effect and some had a floor effect. Only 1 of the 7 PVHI, 5 of the 9 DWMHI, and 1 of the 3 combined rating scales showed a significant correlation with arterial hypertension, a putative risk factor for WMHIs.
Conclusions:
Some of the inconsistencies in previous studies of WMHIs are due to differences in visual rating scales. Our findings may warrant international debate regarding harmonization of WMHI ratings.
Insights
Differences in visual rating scales explain inconsistencies in white matter hyperintensities (WMHIs) studies. Harmonizing these scales is crucial for consistent research on WMHIs and their clinical correlates.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Previous studies on white matter hyperintensities (WMHIs) report conflicting findings regarding their frequency, extent, and clinical associations.
- These inconsistencies may stem from the varied properties of visual rating scales used to assess WMHIs.
Purpose of the Study:
- To investigate whether variations in visual rating scales contribute to the discrepancies observed in previous WMHI research.
- To compare the performance of 13 different rating scales for periventricular (PVHIs) and deep white matter hyperintensities (DWMHIs).
Main Methods:
- Systematic analysis of PVHIs and DWMHIs in 395 poststroke patients, transforming data to align with 13 distinct rating scales.
- Comparison of scales using Goodman-Kruskal measures of association, calculating relative frequencies, means, medians, and Spearman correlations with hypertension.
Main Results:
- Inter-scale agreement varied significantly, with some scales achieving >80% concordance and others as low as 0.4% for PVHI and 18% for DWMHI.
- Scales exhibited differences in patient categorization (8% for PVHI to 57% for DWMHI at worst) and showed ceiling or floor effects when assessing age-related WMHI changes.
- Only a subset of scales demonstrated a significant correlation with arterial hypertension, a known risk factor for WMHIs.
Conclusions:
- Discrepancies in WMHI research are partly attributable to the use of different visual rating scales.
- The findings suggest a need for international discussion and potential harmonization of WMHI rating scales to improve research consistency.