Jochems Angela C C, Muñoz Maniega Susana, Clancy Una, Arteaga Reyes Carmen, Jaime Garcia Daniela, Valdés Hernández Maria Del C, Chappell Francesca M, Barclay Gayle, Jardine Charlotte, McIntyre Donna, Gerrish Iona, Wiseman Stewart, Stringer Michael S, Thrippleton Michael J, Doubal Fergus, Wardlaw Joanna M
UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK.
Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK.
Stroke Vasc Neurol. 2025 Jun 30;10(3):411-414. doi: 10.1136/svn-2024-003300.
White matter hyperintensity (WMH) progression is well documented; WMH regression is more contentious, which might reflect differences in defining WMH change. We compared four existing WMH change definitions in one population to determine the effect of definition on WMH regression.
We recruited patients with minor non-disabling ischaemic stroke who underwent MRI 1-3 months after stroke and 1 year later. We assessed WMH volume (in absolute mL and % intracranial volume) and applied four different definitions, including two thresholds (based on SD or mL), percentile and quintile approaches.
In 198 participants, mean age 65.5 (SD=11.13), baseline WMH volume was 15.46 mL (SD=19.2), the mean net WMH volume change was 0.98 mL (SD=2.84), range -7.98 to +12.84 mL. Proportion regressing/stable/progressing WMH were threshold 1 (SD), 29.8%/55.6%/14.6%; threshold 2(mL), 29.8%/16.7%/53.5%; percentile approach, 28.3%/21.2%/50.5%. The quintile approach includes five groups with quintile 3 reflecting no change (N=40), quintiles 1 and 2 any WMH decrease (N=80) and quintiles 4 and 5 any WMH increase (N=78).
Different WMH change definitions cause big differences in how participants are categorised; additionally, non-normal WMH distribution precludes use of some definitions. Consistent use of an appropriate definition would facilitate data comparisons, particularly in clinical trials of potential WMH treatments.
白质高信号（WMH）进展已有充分记录；WMH 消退则更具争议性，这可能反映了在定义 WMH 变化方面的差异。我们在同一人群中比较了四种现有的 WMH 变化定义，以确定定义对 WMH 消退的影响。
我们招募了轻度非致残性缺血性卒中患者，这些患者在卒中后 1 - 3 个月及 1 年后接受了 MRI 检查。我们评估了 WMH 体积（以绝对毫升数和占颅内体积的百分比表示），并应用了四种不同的定义，包括两个阈值（基于标准差或毫升数）、百分位数和五分位数方法。
198 名参与者，平均年龄 65.5（标准差 = 11.13），基线 WMH 体积为 15.46 毫升（标准差 = 19.2），平均 WMH 体积净变化为 0.98 毫升（标准差 = 2.84），范围为 -7.98 至 +12.84 毫升。WMH 消退/稳定/进展的比例在阈值 1（标准差）时为 29.8%/55.6%/14.6%；阈值 2（毫升）时为 29.8%/16.7%/53.5%；百分位数方法时为 28.3%/21.2%/50.5%。五分位数方法包括五组，其中第 3 五分位数表示无变化（N = 40），第 1 和第 2 五分位数表示任何 WMH 减少（N = 80），第 4 和第 5 五分位数表示任何 WMH 增加（N = 78）。
不同的 WMH 变化定义导致参与者分类方式存在很大差异；此外，WMH 的非正态分布排除了某些定义的使用。一致使用适当的定义将有助于数据比较，特别是在潜在 WMH 治疗的临床试验中。
