Close correlation between quantitative and qualitative assessments of white matter lesions.
BACKGROUND
White matter lesions (WML) increase with age and are associated with stroke, cognitive decline and dementia. They can be visually rated or computationally assessed.


METHODS
We compared WML Fazekas visual rating scores and volumes, determined using a validated multispectral image-fusion technique, in Magnetic Resonance Imaging from 672 participants of the Lothian Birth Cohort 1936 and sought explanations for subjects in whom the correlation (Spearman's ρ) between the total Fazekas score (summed deep and periventricular ratings, 0-6) and WML volume did not concur (z-score difference >1). Infarcts were identified separately.


RESULTS
The median WML Fazekas score was 2 [inter-quartile range (IQR): 2], median WML volume 7.7 ml (IQR: 13.6 ml) and median infarct volume (n = 95) 0.98 ml. Score and volume were highly correlated (Spearman's ρ = 0.78, p < 0.001). Infarcts did not alter the correlation. Minor discordance occurred in 94/672 (14%) subjects, most with total Fazekas score of 1 (n = 20, WML volume = 4.5-14.8 ml) or 2 (n = 50, WML volume = 0.1-34.4 ml). The main reasons were: subtle WML identified visually but omitted from the volume; prominent ventricular caps but thin body lining giving a periventricular score of 1/2 but large WML volume, and small deep focal lesions which increase the score disproportionally when beginning to coalesce with little change in WML volume.


CONCLUSIONS
WML rating scores and volumes provide near-equivalent estimates of WML burden, therefore either can be used depending on research circumstances. Even closer agreement could result from improved computational detection of subtle WML and modified visual ratings to differentiate prominent ventricular caps from thin periventricular linings, and small non-coalescent from early coalescent deep WML.
Brain Research Imaging Centre, Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK. mvhernan@staffmail.ed.ac.uk
Maria del C
Mdel C
Valdés Hernández
Zoe
Z
Morris
David Alexander
DA
Dickie
Natalie A
NA
Royle
Susana
S
Muñoz Maniega
Benjamin S
BS
Aribisala
Mark E
ME
Bastin
Ian J
IJ
Deary
Joanna M
JM
Wardlaw
D000368:Aged; D002544:Cerebral Infarction / Q000453:epidemiology / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000473:pathology*