Brain Research Imaging Centre, Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK.
Neuroepidemiology. 2013;40(1):13-22. doi: 10.1159/000341859. Epub 2012 Oct 11.
White matter lesions (WML) increase with age and are associated with stroke, cognitive decline and dementia. They can be visually rated or computationally assessed.
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.
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.
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.
脑白质病变（WML）随年龄增长而增加，与中风、认知能力下降和痴呆有关。可以对其进行视觉评估或通过计算进行评估。
我们比较了 672 名洛锡安出生队列 1936 研究参与者的磁共振成像中的 WML Fazekas 视觉评分和体积，该体积使用经过验证的多光谱图像融合技术确定，并寻找那些总 Fazekas 评分（深部和脑室周围评分之和，0-6）与 WML 体积之间的相关性（Spearman's ρ）不一致的受试者（z 分数差异>1）的解释。单独确定了梗塞。
WML Fazekas 评分中位数为 2 [四分位距（IQR）：2]，WML 体积中位数为 7.7ml（IQR：13.6ml），梗塞体积中位数（n=95）为 0.98ml。评分和体积高度相关（Spearman's ρ=0.78，p<0.001）。梗塞并未改变相关性。在 94/672（14%）名受试者中出现了轻微的不一致，大多数受试者的总 Fazekas 评分为 1（n=20，WML 体积=4.5-14.8ml）或 2（n=50，WML 体积=0.1-34.4ml）。主要原因是：视觉上识别到但未包含在体积中的细微 WML；明显的脑室盖但薄的体衬，导致脑室周围评分为 1/2，但 WML 体积较大，以及小的深部局灶性病变，当开始融合时，评分不成比例增加，而 WML 体积几乎没有变化。
WML 评分和体积提供了 WML 负担的近似等效估计，因此可以根据研究情况选择使用。通过改进对细微 WML 的计算检测以及修改视觉评分以区分明显的脑室盖和薄的脑室周围衬里，以及区分非融合的小深部和早期融合的深部 WML，可能会得到更紧密的一致性。
