Andere Ariana, Jindal Gaurav, Molino Janine, Collins Scott, Merck Derek, Burton Tina, Stretz Christoph, Yaghi Shadi, Sacchetti Daniel C, Jamal Sleiman El, Reznik Michael E, Furie Karen, Cutting Shawna
Department of Neurology, Brown University, Providence, RI, United States.
Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, United States.
J Stroke Cerebrovasc Dis. 2022 Apr;31(4):106333. doi: 10.1016/j.jstrokecerebrovasdis.2022.106333. Epub 2022 Feb 11.
White matter hyperintensity (WMH) is an abnormal T2 signal in the deep and subcortical white matter visualized on MRI associated with hypertension, cerebrovascular disease, and aging. The Fazekas (Fz) scoring system is a commonly used qualitative tool to assess the severity of WMH. While studies have compared Fazekas scores to other scoring methods, the comparison of Fazekas scores and volume of WMH using current semiautomated volumetric techniques has not been studied.
We reviewed MRI studies acquired at our institution between 2015 and 2017. Relative WMH was scored by one author trained in Fazekas scoring. A board certified neuroradiologist scored them independently for confirmation. Manual segmentations of WMH were completed using 3D Slicer 4.9. A 3D model was formed to quantify WMH in milliliters (mL). ANOVA tests were performed to determine the association of Fazekas scores with corresponding WMH volumes.
Among the 198 patients in our study, WMH were visualized in 163 (Fz1: n=66; Fz2: n=49; Fz3: n=48). WMH volumes significantly differed according to Fazekas score (F = 141.1, p<0.001), with increasing WMHV associated with higher Fazekas scores: Fz1, range 0.1-8.3 mL (mean 3.7, SD 2.3); Fz2, range 6.0-17.7 mL (mean 10.8, SD 3.1); Fz3, range 14.2-77.2 mL (mean 35.2, SD 17.9); and Fz3 (excluding 11 outliers above 50 mL), 14.2-47.0 mL (mean 27.1, SD 8.9).
Fazekas scores correspond with distinct ranges of WMH volume with relatively little overlap, but scores based on volumes are more efficacious. A modified Fazekas from 0-4 should be considered.
白质高信号（WMH）是指在MRI上显示的深部及皮质下白质的异常T2信号，与高血压、脑血管疾病及衰老相关。Fazekas（Fz）评分系统是评估WMH严重程度常用的定性工具。虽然已有研究将Fazekas评分与其他评分方法进行比较，但使用当前半自动容积技术对Fazekas评分与WMH体积进行比较的研究尚未开展。
我们回顾了2015年至2017年在我院进行的MRI研究。由一名接受过Fazekas评分培训的作者对相对WMH进行评分。一名获得委员会认证的神经放射科医生独立评分以作确认。使用3D Slicer 4.9完成WMH的手动分割。构建3D模型以量化以毫升（mL）为单位的WMH。进行方差分析测试以确定Fazekas评分与相应WMH体积之间的关联。
在我们研究的198例患者中，163例可见WMH（Fz1：n = 66；Fz2：n = 49；Fz3：n = 48）。WMH体积根据Fazekas评分有显著差异（F = 141.1，p < 0.001），WMH体积增加与更高的Fazekas评分相关：Fz1，范围0.1 - 8.3 mL（平均3.7，标准差2.3）；Fz2，范围6.0 - 17.7 mL（平均10.8，标准差3.1）；Fz3，范围14.2 - 77.2 mL（平均35.2，标准差17.9）；以及Fz3（排除50 mL以上的11个异常值），14.2 - 47.0 mL（平均27.1毫升，标准差8.9）。
Fazekas评分与WMH体积的不同范围相对应，重叠较少，但基于体积的评分更有效。应考虑采用0至4的改良Fazekas评分。
