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(Stroke. 2001;32:1318.)
© 2001 American Heart Association, Inc.

Original Contributions

A New Rating Scale for Age-Related White Matter Changes Applicable to MRI and CT

L. O. Wahlund, MD, PhD; F. Barkhof, MD, PhD; F. Fazekas, MD; L. Bronge, MD; M. Augustin, MD; M. Sjögren, MD, PhD; A. Wallin, MD, PhD; H. Ader, PhD; D. Leys, MD, PhD; L. Pantoni, MD, PhD; F. Pasquier, MD, PhD; T. Erkinjuntti, MD, PhD; P. Scheltens, MD, PhD on behalf of the European Task Force on Age-Related White Matter Changes

From the Department of Clinical Neuroscience, NEUROTEC (L.O.W.), and Department of Radiology (L.B.), Karolinska Institutet at Huddinge University Hospital, Huddinge, Sweden; Departments of Radiology (F.B., P.S.) and Neurology (P.S.), Research Institute Neurosciences, Academisch Ziekenhuis Vrije Universitet, Amsterdam, the Netherlands; Department of Neurology and MR Center, Karl-Franzens University (F.F. M.A.), Graz, Austria; Institute of Clinical Neuroscience, Section of Psychiatry, Göteborg University (M.S., A.W.), Mölndal, Sweden; Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Vrije Universitet (H.A.), Amsterdam, the Netherlands; Service de Neurologie Vasculaire, Hopital Roger Salengro (D.L., F.P.), Lille, France; Department of Neurological and Psychiatric Sciences, University of Florence (L.P.), Florence, Italy; and Memory Research Unit, Department of Clinical Neuroscience, Helsinki University Central Hospital (T.E.), Helsinki, Finland.

Correspondence to L.O. Wahlund, MD, PhD, Department of Clinical Neuroscience, NEUROTEC, B 56, Huddinge University Hospital, S-141 86 Huddinge, Sweden. E-mail lars-olof.wahlund{at}neurotec.ki.se

Background and Purpose—MRI is more sensitive than CT for detection of age-related white matter changes (ARWMC). Most rating scales estimate the degree and distribution of ARWMC either on CT or on MRI, and they differ in many aspects. This makes it difficult to compare CT and MRI studies. To be able to study the evolution and possible effect of drug treatment on ARWMC in large patient samples, it is necessary to have a rating scale constructed for both MRI and CT. We have developed and evaluated a new scale and studied ARWMC in a large number of patients examined with both MRI and CT.

Methods—Seventy-seven patients with ARWMC on either CT or MRI were recruited and a complementary examination (MRI or CT) performed. The patients came from 4 centers in Europe, and the scans were rated by 4 raters on 1 occasion with the new ARWMC rating scale. The interrater reliability was evaluated by using statistics. The degree and distribution of ARWMC in CT and MRI scans were compared in different brain areas.

Results—Interrater reliability was good for MRI (=0.67) and moderate for CT (=0.48). MRI was superior in detection of small ARWMC, whereas larger lesions were detected equally well with both CT and MRI. In the parieto-occipital and infratentorial areas, MRI detected significantly more ARWMC than did CT. In the frontal area and basal ganglia, no differences between modalities were found. When a fluid-attenuated inversion recovery sequence was used, MRI detected significantly more lesions than CT in frontal and parieto-occipital areas. No differences were found in basal ganglia and infratentorial areas.

Conclusions—We present a new ARWMC scale applicable to both CT and MRI that has almost equal sensitivity, except for certain regions. The interrater reliability was slightly better for MRI, as was the detectability of small lesions.

Key Words: dementia • magnetic resonance imaging • rating scales • tomography, x-ray computed • white matter

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