Visual Rating Scales of White Matter Hyperintensities and Atrophy: Comparison of Computed Tomography and Magnetic Resonance Imaging

doi:10.1016/j.jstrokecerebrovasdis.2018.02.028

Journal of Stroke and Cerebrovascular Diseases

Volume 27, Issue 7, July 2018, Pages 1815-1821

https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.028 Get rights and content

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Goal

Magnetic resonance imaging (MRI) is the preferred modality for research on structural age-related brain changes. However, computed tomography (CT) is widely available and has practical and cost advantages over MRI for large-scale brain imaging research studies in acutely unwell patients. However, the relationships between MRI and CT measures of white matter hyperintensities (WMH) and atrophy are unclear. We examined the relationships between visual ratings of WMH, atrophy, and old infarcts in patients who had both CT and MRI scans.

Materials and Methods

Patients who had both CT and MRI scans in the International Stroke Trial-3 were studied. In both modalities, 2 raters independently completed standardized visual rating scales for WMH, and for central and superficial atrophy using a 5-point scale. In addition, 1 rater recorded old infarcts according to size and location.

Findings

Seventy patients with a mean age of 69 years were studied. There were moderate to substantial intrarater CT–MRI agreements for periventricular components of WMH scales (weighted Κappa = .55-.75). Agreements for basal ganglia ratings were lower (weighted Κappa = .18-.44), partly because of the misclassification of prominent perivascular spaces. Atrophy scales showed moderate to substantial CT–MRI agreements (weighted Κappa = .44-.70). MRI was more sensitive in the detection of smaller infarcts and cavitated lesions.

Conclusions

Standardized visual rating scales of white matter lesions and atrophy mostly show substantial agreement between CT and MRI. Clinical CT scans have a strong potential for wider exploitation in research studies, particularly in acutely unwell populations.

Key Words

Computed tomography

magnetic resonance imaging

cerebral atrophy

white matter lesions

validity

Cited by (0)

: Grant support: V.C. was supported by an NRS Fellowship from the Chief Scientist Office, Scotland; K.J.F. was supported by the Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh; Carestream software was provided by the Brain Research Imaging Centre, University of Edinburgh. IST-3 Source of funding: Stroke Association, UK, Health Foundation UK, UK MRC (grant numbers G0400069) and managed by the NIHR on behalf of the MRC-NIHR partnership; Efficacy, Mechanisms and Evaluation (EME) program (EME 09-800-15), which is funded by the Medical Research Council (MRC) and the National Institute for Health Research (NIHR), with contributions from the Chief Scientist Office (CSO) in Scotland, the National Institute for Social Care and Health Research (NISCHR) in Wales, and the Health and Social Care Research and Development (HSC R&D), Public Health Agency in Northern Ireland, and is managed by the NIHR, The Research Council of Norway; Arbetsmarknadens Partners Forsakringsbolag (AFA) Insurances Sweden; the Swedish Heart Lung Fund; The Foundation of Marianne and Marcus Wallenberg, Stockholm County Council; Karolinska Institute Joint ALF-project grants Sweden, the Polish Ministry of Science and Education (grant number 2PO5B10928); the Australian Heart Foundation; the Australian National Health and Medical Research Council; the Swiss National Research Foundation; the Swiss Heart Foundation; the Foundation for Health and Cardio-Neurovascular Research, Basel, Switzerland; the Assessorato alla Sanita, Regione dell'Umbria, Italy; and Danube University, Krems, Austria. Boehringer-Ingelheim GmbH donated drug and placebo for the 300 patients in the double-blind phase but thereafter had no role whatsoever in the trial. The UK Stroke Research Network (SRN study ID 2135) adopted the trial in 01/05/2006, supported the initiation of new UK sites, and in some centers, and, after that date, data collection was undertaken by staff funded by the network or working for associated National Health Service (NHS) organizations. IST-3 gratefully acknowledges the extensive support of the NIHR Stroke Research Network, NHS Research Scotland, through the Scottish SRN, and the National Institute for Social Care and Health Research Clinical Research Centre. The Scottish Imaging Network—A Platform for Scientific Excellence (SINAPSE) collaboration (www.sinapse.ac.uk) was funded by the Scottish Funding Council and the CSO of the Scottish Executive. Additional support was received from Chest Heart and Stroke Scotland, DesAcc, University of Edinburgh, Danderyd Hospital Research and Development Department, Karolinska Institutet, Oslo University Hospital, and the Dalhousie University Internal Medicine Research Fund. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the funding agencies or the UK Department of Health.