CT and MRI rating of white matter changes
The impact of white matter changes (WMC) detectable on CT or MRI on various diseases like ischemic stroke and intracerebral hemorrhage and their association with cognitive impairment was and still is under debate. To assess WMC in a qualitative and/or sem
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Summary. The impact of white matter changes (WMC) detectable on CT or MRI on various diseases like ischemic stroke and intracerebral hemorrhage and their association with cognitive impairment was and still is under debate. To assess WMC in a qualitative and/or semiquantitative fashion rating scales have been developed. For MRI most widely used scales are the scales of Manolio, Fazekas, Schmidt, and Scheltens. Most recently a new scale extending earlier suggestions has been introduced by Wahlund et al. applicable for both CT and MRI. This article will review strengths and weaknesses of these rating scales and will discuss further requirements and future perspectives.
Introduction The detection of cerebral white matter changes (WMC) on computed tomography (CT) or magnetic resonance imaging (MRI) led to considerable discussion concerning the clinical relevance of these abnormalities. Their possible association with ischemic stroke (Mantyla et aI., 1999), intra cerebral hemorrhage (ICH) (Offenbacher et aI., 1996) or dementia (Fazekas et aI., 1994) put their presence, pattern and extent in the centre of interest of many research groups. One way to further improve our knowledge concerning WMC is to enlarge the number of investigated individuals, i.e. to pool data for increasing statistical power. Collaboration between different sites is needed to reach this goal and has been established. However, common form of evaluating WMC either by CT or MRI is also crucial. This includes both data generation which may be accomplished with different hard and soft ware, e.g. due to different scanners and scanning parameters and data analyses. Visual rating scales for WMC may overcome some of these problems as they are applicable to different settings or image quality and they have few "technical" requirements. However, available scales are highly heterogeneous and few of them have been tested regarding interrater agreement. Moreover, no data are available concerning the correlation between different scales. One of the goals of the "European Task Force on Age Related WMC" has been to provide more insight into the performance of the various scales in use
K. A. Jellinger et al. (eds.), Ageing and Dementia Current and Future Concepts © Springer-Verlag/Wein 2002
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(Scheltens et al., 1998) . Most recently Wahlund et al. (2001) introduced a new rating scale for CT and MRI. Furthermore, in a comparison of scales it was attempted to address differences in reliability and distribution of abnormal ratings which may account for either a low sensitivity or ceiling effects to potentially enable a comparison of data obtained with both modalities. Work in this concern is currently in progress. Some widely used scales
The scales of Fazekas and Schmidt (Fazekas et al., 1987; Schmidt et al., 1992), Scheltens et al. (1993) , and Manolio et al, (1994) are frequently used scales which are tested for their inter and intrarater reliability. While the scales of Fazekas, Schmidt and Scheltens are very similar, the scale of Manolio is
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