Classification of White Matter Lesions on Magnetic Resonance Imaging in Elderly Persons

doi:10.1016/j.biopsych.2008.03.024

Biological Psychiatry

Volume 64, Issue 4, 15 August 2008, Pages 273-280

https://doi.org/10.1016/j.biopsych.2008.03.024 Get rights and content

White matter lesions, commonly seen on MRIs of elderly people, are related to various geriatric disorders, including cerebrovascular diseases, cardiovascular diseases, dementia, and psychiatric disorders. Currently, white matter lesions are divided into periventricular white matter lesions and deep white matter lesions. Although the meaning of these terms varies by study and this dichotomization itself is still in debate, a possible dissimilarity in pathogenic mechanisms between periventricular white matter lesions and deep white matter lesions are providing some clues for understanding pathophysiology of many geriatric syndromes associated with white matter lesions. We have reviewed the distinctions between periventricular white matter lesions and deep white matter lesions in terms of etiology, histopathology, functional correlates, and imaging methodologies. We suggest a new subclassification of white matter lesions that might have better etiological and functional relevance than the current simple dichotomization. The new categories are juxtaventricular, periventricular, deep white, and juxtacortical. This new classification scheme might contribute to reducing the heterogeneity of white matter lesion findings in future research.

Section snippets

Definitions of PVWML and DWML

Fazekas et al. (16) were first to rate PVWML and DWML separately. They defined PVWML as WMLs contiguous with the margins of each lateral ventricle and DWMLs as those separate to it. This “continuity [to ventricle] rule” has been applied in most of the visual rating scales for WMLs (14, 16, 18, 26, 27, 28). In those scales, other characteristics of WMLs, such as their shape, size, and number, were not used in defining PVWML but were used instead in grading the severity of PVWML, shape of WMLs (16

Volumetric and Quantitative Scoring of WMLs

Until recently, the measurement of WMLs involved qualitative or semi-quantitative visual rating scales. These scales were defined to serve various purposes, including overall WML rating, PVWML rating, and differential rating for PVWML and DWML, and thus scores from different rating scales are not directly comparable. This heterogeneity of scales likely contributed to the inconsistent results in previous studies on WMLs (69). In addition, visual rating scales inevitably have some limitations,

Suggestions for Future Research

To improve the value of WMLs as etiological or prognostic markers in research and clinical settings, it is critical to reduce the heterogeneity of WML definition and measurement. To reduce the heterogeneity in measurement of WMLs, it is necessary to eliminate the inconsistencies in detecting and subclassifying methods for WMLs.

Although the majority of MRI studies of WML have been conducted on 1.5T MR scanners, this will change with the increased availability of high-field MR scanners. With a

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To examine the relation between baseline white matter hyperintensities (WMH) and change in naming, content production, and efficiency after treatment in subacute aphasia. We hypothesized that more severe baseline WMH would result in less improvement with treatment.
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We retrospectively reviewed imaging and behavioral data for 52 participants with subacute aphasia due to left-hemisphere ischemic stroke enrolled in the RCT. RCT inclusion criteria: English proficiency, normal/corrected-to-normal hearing/vision, and no history of neurologic conditions other than the stroke resulting aphasia. One participant with a chronic right-hemisphere lesion was retained as she presented with no residual deficits on neurologic examination. Individuals with scalp sensitivities or on medications that lower seizure threshold or any N-methyl-D-aspartate (NMDA) antagonists were excluded. Of the 52 participants, for this analysis, 2 were excluded for not having a magnetic resonance imaging, and 7 were excluded for not participating in treatment or pre/post assessment for at least 1 outcome, resulting in final sample of 43 participants (20 women sex, M [SD] age=64.4 [11.9] and M [SD] education=14.9 [3.1] years).
Participants received 15 sessions (2-3 times/week) of computerized lexical-semantic (ie, verification) treatment with [sham/active] transcranial direct current stimulation (tDCS). Sessions were approximately 45 minutes each (tDCS for first 20 minutes).
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Periventricular WMH severity was independently associated with recovery in picture naming for the active tDCS group. Deep WMH severity was associated with recovery for CU production for the sham tDCS group.
Baseline periventricular and deep WMH, among other factors, may be an important consideration for prognosis and treatment planning, especially when considered in conjunction with tDCS treatment.
Characterizing upper extremity fine motor function in the presence of white matter hyperintensities: A 7 T MRI cross-sectional study in older adults
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White matter hyperintensities (WMH) are a prevalent radiographic finding in the aging brain studies. Research on WMH association with motor impairment is mostly focused on the lower-extremity function and further investigation on the upper-extremity is needed. How different degrees of WMH burden impact the network of activation recruited during upper limb motor performance could provide further insight on the complex mechanisms of WMH pathophysiology and its interaction with aging and neurological disease processes.
40 healthy elderly subjects without a neurological/psychiatric diagnosis were included in the study (16F, mean age 69.3 years). All subjects underwent ultra-high field 7 T MRI including structural and finger tapping task-fMRI. First, we quantified the WMH lesion load and its spatial distribution. Secondly, we performed a data-driven stratification of the subjects according to their periventricular and deep WMH burdens. Thirdly, we investigated the distribution of neural recruitment and the corresponding activity assessed through BOLD signal changes among different brain regions for groups of subjects. We clustered the degree of WMH based on location, numbers, and volume into three categories; ranging from mild, moderate, and severe. Finally, we explored how the spatial distribution of WMH, and activity elicited during task-fMRI relate to motor function, measured with the 9-Hole Peg Test.
Within our population, we found three subgroups of subjects, partitioned according to their periventricular and deep WMH lesion load. We found decreased activity in several frontal and cingulate cortex areas in subjects with a severe WMH burden. No statistically significant associations were found when performing the brain-behavior statistical analysis for structural or functional data.
WMH burden has an effect on brain activity during fine motor control and the activity changes are associated with varying degrees of the total burden and distributions of WMH lesions. Collectively, our results shed new light on the potential impact of WMH on motor function in the context of aging and neurodegeneration.
Automatic segmentation of white matter hyperintensities in T2-FLAIR with AQUA: A comparative validation study against conventional methods
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White matter hyperintensities (WMHs) are lesions in the white matter of the brain that are associated with cognitive decline and an increased risk of dementia. The manual segmentation of WMHs is highly time-consuming and prone to intra- and inter-variability. Therefore, automatic segmentation approaches are gaining attention as a more efficient and objective means to detect and monitor WMHs. In this study, we propose AQUA, a deep learning model designed for fully automatic segmentation of WMHs from T2-FLAIR scans, which improves upon our previous study for small lesion detection and incorporating a multicenter approach. AQUA implements a two-dimensional U-Net architecture and uses patch-based training. Additionally, the network was modified to include Bottleneck Attention Module on each convolutional block of both the encoder and decoder to enhance performance for small-sized WMH. We evaluated the performance and robustness of AQUA by comparing it with five well-known supervised and unsupervised methods for automatic segmentation of WMHs (LGA, LPA, SLS, UBO, and BIANCA). To accomplish this, we tested these six methods on the MICCAI 2017 WMH Segmentation Challenge dataset, which contains MRI images from 170 elderly participants with WMHs of presumed vascular origin, and assessed their robustness across multiple sites and scanner types. The results showed that AQUA achieved superior performance in terms of spatial (Dice = 0.72) and volumetric (logAVD = 0.10) agreement with the manual segmentation compared to the other methods. While the recall and F1-score were moderate at 0.49 and 0.59, respectively, they improved to 0.75 and 0.82 when excluding small lesions (≤ 6 voxels). Remarkably, despite being trained on a different dataset with different ethnic backgrounds, lesion loads, and scanners, AQUA's results were comparable to the top 10 ranked methods of the MICCAI challenge. The findings suggest that AQUA is effective and practical for automatic segmentation of WMHs from T2-FLAIR scans, which could help identify individuals at risk of cognitive decline and dementia and allow for early intervention and management.
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ReviewClassification of White Matter Lesions on Magnetic Resonance Imaging in Elderly Persons

Section snippets

Definitions of PVWML and DWML

Volumetric and Quantitative Scoring of WMLs

Suggestions for Future Research

NeuroImage

Biol Psychiatry

J Neurol Sci

Neurobiol Aging

Biol Psychiatry

J Affect Disord

Neurobiol Aging

NeuroImage

Psychiatry Res

NeuroImage

Med Image Anal

Magn Reson Imaging

J Neurol Sci

Biol Psychiatry

Biol Psychiatry

Microvasc Res

Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: The Rotterdam Study

Neurology

Prevalence of cerebral white matter lesions in elderly people: A population based magnetic resonance imaging studyThe Rotterdam Scan Study

J Neurol Neurosurg Psychiatry

Prevalence of white matter hyperintensities in a young healthy population

J Neuroimaging

Regional variability in the prevalence of cerebral white matter lesions: An MRI study in 9 European countries (CASCADE)

Neuroepidemiology

White matter hyperintensities on MRI in the neurologically nondiseased elderlyAnalysis of cohorts of consecutive subjects aged 55 to 85 years living at home

Stroke

Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese elderly diabetes intervention trial (J-EDIT)

Diabetes Metab Res Rev

Cerebral white matter lesions and cognitive function: The Rotterdam Scan Study

Ann Neurol

Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly peopleThe Cardiovascular Health Study

Stroke

White matter hyperintensities are related to physical disability and poor motor function

J Neurol Neurosurg Psychiatry

Pathologic correlates of incidental MRI white matter signal hyperintensities

Neurology

White matter hyperintensity on cranial magnetic resonance imaging: A predictor of stroke

Stroke

Extent and distribution of white matter hyperintensities in stroke patients: The Sydney Stroke Study

Stroke

Carotid atherosclerosis and cerebral white matter lesions in a population based magnetic resonance imaging study

J Neurol

Cerebral white matter lesions and the risk of dementia

Arch Neurol

MR signal abnormalities at 1.5 T in Alzheimer‘s dementia and normal aging

AJR Am J Roentgenol

Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD

Neurology

Subcortical hyperintensity on magnetic resonance imaging: A comparison of normal and depressed elderly subjects

Am J Psychiatry

A magnetic resonance imaging study of white matter lesions in depression and Alzheimer‘s disease

Br J Psychiatry

Subcortical abnormalities detected in bipolar affective disorder using magnetic resonance imagingClinical and neuropsychological significance

Arch Gen Psychiatry

White matter lesions, quantitative magnetic resonance imaging, and dementia

Alzheimer Dis Assoc Disord

Role of magnetic resonance imaging in the diagnosis and monitoring of multiple sclerosis: Consensus report of the White Matter Study Group

J Magn Reson Imaging

White matter changes in normal pressure hydrocephalus and Binswanger disease: Specificity, predictive value and correlations to axonal degeneration and demyelination

Acta Neurol Scand

Cerebral MRI abnormalities and their association with neuropsychiatric manifestations in SLE: A population-based study

Scand J Rheumatol

Magnetic resonance imaging signal hyperintensities in the deep and subcortical white matterA comparative study between stroke patients and normal volunteers

Arch Neurol

Lack of difference in brain hyperintensities between patients with early Alzheimer's disease and control subjects

Arch Neurol

Anatomical mapping of white matter hyperintensities (WMH): Exploring the relationships between periventricular WMH, deep WMH, and total WMH burden

Stroke

Large-scale neurocognitive networks and distributed processing for attention, language, and memory

Ann Neurol

Cerebral white matter lesions and depressive symptoms in elderly adults

Arch Gen Psychiatry

Relationship between periventricular and deep white matter lesions and depressive symptoms in older peopleThe LADIS Study

Int J Geriatr Psychiatry

Alzheimer's disease: Role of size and location of white matter changes in determining cognitive deficits

Review
Classification of White Matter Lesions on Magnetic Resonance Imaging in Elderly Persons