Evaluation of a Practical Visual MRI Rating Scale of Brain White Matter Hyperintensities for Clinicians Based on Largest Lesion Size Regardless of Location

BACKGROUND AND PURPOSE: Age-related white matter hyperintensities have prognostic implications, but no accepted clinical standard exists for their assessment. We propose a simple objective visual rating system by using 3T brain MR imaging.

MATERIALS AND METHODS: MR imaging from 559 participants was processed by using an automated method to determine WMH volumes and evaluated with a new visual rating scale based on the single largest WMH lesion diameter regardless of location. The reproducibility of the visual system was assessed. The association of WMH visual scores and automated volumes was then compared with cognitive scores from the Montreal Cognitive Assessment, which was available for 510 participants.

RESULTS: Inter-reader reproducibility was good for subsamples with both high (n = 52) and low (n = 40) prevalence of large automated WMH volumes (agreement of 67% and 87.5%, κ = 0.71 and 0.76, respectively). Correlation between increased WMH and cognitive deficit measurements was equal for our visual ratings and automated volumes (Spearman ρ = 0.118 and 0.109; P values = 0.008 and 0.014, respectively). The visual scale retained a significant association with MoCA score after adjusting for age, sex, and education (standardized β = −0.087, P = .042).

CONCLUSIONS: We propose a simple visual WMH scoring system suitable for use as a baseline evaluation in clinical practice.