Bullseye's representation of cerebral white matter hyperintensities - 23/11/17

Doi : 10.1016/j.neurad.2017.10.001

C.H. Sudre ^a,^b,^⁎ , B. Gomez Anson ^c , I. Davagnanam ^d,^e , A. Schmitt ^d , A.F. Mendelson ^a , F. Prados ^a , L. Smith ^f , D. Atkinson ^g , A.D. Hughes ^f , N. Chaturvedi ^f , M.J. Cardoso ^a,^b , F. Barkhof ^a,^e , H.R. Jaeger ^d,^e,^{^{1
HRJ and SO share senior authorship.}} , S. Ourselin ^a,^b,^{^{1
HRJ and SO share senior authorship.}}
^a Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK
^b Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK
^c Santa Creu i Sant Pau Hospital, Universitat Autonòma Barcelona, 08041 Barcelona, Spain
^d Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK
^e Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK
^f Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK
^g Centre for Medical Imaging, UCL Faculty of Medical Science, NW1 2PG London, UK

^⁎Corresponding author. Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, United Kingdom.

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Abstract

Background and purpose

Visual rating scales have limited capacities to depict the regional distribution of cerebral white matter hyperintensities (WMH). We present a regional-zonal volumetric analysis alongside a visualization tool to compare and deconstruct visual rating scales.

Materials and methods

3D T1-weighted, T2-weighted spin-echo and FLAIR images were acquired on a 3T system, from 82 elderly participants in a population-based study. Images were automatically segmented for WMH. Lobar boundaries and distance to ventricular surface were used to define white matter regions. Regional-zonal WMH loads were displayed using bullseye plots. Four raters assessed all images applying three scales. Correlations between visual scales and regional WMH as well as inter and intra-rater variability were assessed. A multinomial ordinal regression model was used to predict scores based on regional volumes and global WMH burdens.

Results

On average, the bullseye plot depicted a right-left symmetry in the distribution and concentration of damage in the periventricular zone, especially in frontal regions. WMH loads correlated well with the average visual rating scores (e.g. Kendall's tau [Volume, Scheltens]=0.59 CI=[0.53 0.62]). Local correlations allowed comparison of loading patterns between scales and between raters. Regional measurements had more predictive power than global WMH burden (e.g. frontal caps prediction with local features: ICC=0.67 CI=[0.53 0.77], global volume=0.50 CI=[0.32 0.65], intra-rater=0.44 CI=[0.23 0.60]).

Conclusion

Regional-zonal representation of WMH burden highlights similarities and differences between visual rating scales and raters. The bullseye infographic tool provides a simple visual representation of regional lesion load that can be used for rater calibration and training.

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Keywords : White matter hyper intensities, Visual rating scales, Magnetic resonance imaging, Location, Ageing

Abbreviations : BG, CI, FLAIR, ICC, IQR, IT, JC, K_τ, MR, PV, SD, WMH