Comparison of qualitative and fully automated quantitative tools for classifying severity of white matter hyperintensity

Ryuya Okawa; Norio Hayashi; Tetsuhiko Takahashi; Ryo Atarashi; Go Yasui; Ban Mihara

doi:10.1016/j.jstrokecerebrovasdis.2024.107772

Comparison of qualitative and fully automated quantitative tools for classifying severity of white matter hyperintensity

J Stroke Cerebrovasc Dis. 2024 May 17;33(8):107772. doi: 10.1016/j.jstrokecerebrovasdis.2024.107772. Online ahead of print.

Authors

Ryuya Okawa¹, Norio Hayashi², Tetsuhiko Takahashi³, Ryo Atarashi⁴, Go Yasui⁵, Ban Mihara⁶

Affiliations

¹ Department of Diagnostic Imaging, Institute of Brain and Blood Vessels Mihara Memorial Hospital; Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences. Electronic address: ryuya01090627@yahoo.co.jp.
² Department of Radiological Technology, Gunma Prefectural College of Health Sciences. Electronic address: hayashi@gchs.ac.jp.
³ Department of Radiological Technology, Gunma Prefectural College of Health Sciences. Electronic address: ttakahashi@gchs.ac.jp.
⁴ Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences. Electronic address: mr225101@gchs.ac.jp.
⁵ Department of Diagnostic Imaging, Institute of Brain and Blood Vessels Mihara Memorial Hospital. Electronic address: go.yasui@mihara-ibbv.jp.
⁶ Department of Neurology, Institute of Brain and Blood Vessels Mihara Memorial Hospital. Electronic address: mmh-gazou@mihara-ibbv.jp.

PMID: 38761849
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107772

Abstract

Objective: In this study, we aimed to compare the Fazekas scoring system and quantitative white matter hyperintensity volume in the classification of white matter hyperintensity severity using a fully automated analysis software to investigate the reliability of quantitative evaluation.

Materials and methods: Patients with suspected cognitive impairment who underwent medical examinations at our institution between January 2010 and May 2021 were retrospectively examined. White matter hyperintensity volumes were analyzed using fully automated analysis software and Fazekas scoring (scores 0-3). Using one-way analysis of variance, white matter hyperintensity volume differences across Fazekas scores were assessed. We employed post-hoc pairwise comparisons to compare the differences in the mean white matter hyperintensity volume between each Fazekas score. Spearman's rank correlation test was used to investigate the association between Fazekas score and white matter hyperintensity volume.

Results: Among the 839 patients included in this study, Fazekas scores 0, 1, 2, and 3 were assigned to 68, 198, 217, and 356 patients, respectively. White matter hyperintensity volumes significantly differed according to Fazekas score (F=623.5, p<0.001). Post-hoc pairwise comparisons revealed significant differences in mean white matter hyperintensity volume between all Fazekas scores (p<0.05). We observed a significantly positive correlation between the Fazekas scores and white matter hyperintensity volume (R=0.823, p<0.01).

Conclusions: Quantitative white matter hyperintensity volume and the Fazekas scores are highly correlated and may be used as indicators of white matter hyperintensity severity. In addition, quantitative analysis may be more effective in classifying advanced white matter hyperintensity lesions than the Fazekas classification.

Keywords: Cognitive impairment; Fazekas scoring system; Fluid-attenuated inversion recovery image; Fully automated analysis software; Magnetic resonance imaging; White matter hyperintensity; White matter volume.