Abstract WP395: Classification of Periventricular White Matter Disease (WMD) in Clinical Radiology Reports vs. Direct Film Review in Ischemic Stroke Patients
Background: Severe WMD is associated with post-stroke mortality, recurrent stroke risk, cognitive decline, and poor functional outcomes. We have previously reported that “severe” WMD grade is likely when the clinical radiology report includes the words “severe, extensive, advanced, or diffuse”. We examined whether terms consistent with the Fazekas WMD grading scale (none, mild, moderate, or severe) in clinical radiology reports can be used to categorize WMD severity in epidemiologic stroke studies, and sought to repeat our factor analysis with descriptive terms.
Methods: Clinical reports from 688 ischemic stroke subjects with MRI or CT films from 2010 were reviewed by physician investigators, who recorded whether WMD was described and whether the Fazekas terms or similar descriptors (such as diffuse, patchy, extensive, etc.) were used. A stroke neurologist and a research assistant independently evaluated available neuroimaging studies and categorized WMD severity according to the Fazekas grades. WMD was preferentially graded on MRI scans; CT scans were assessed if MRIs were unavailable or not performed. Kappa statistic was used to compare the grade mentioned in the report with our direct review; factor analysis was applied to the descriptor terms and logistic regression performed to examine predictive value of descriptor terms with WMD grade from direct review.
Results: Of the 688, 276 had WMD radiologist grades available, 222 had no grades and no descriptors, and 190 had no grades but had descriptors. For all films with grades available, the weighted kappa score was 0.30, indicating poor agreement between the radiologist’s WMD grade and the reviewer’s WMD grade. Examining only the 231 MRI studies with WMD grades did not improve the weighted kappa score (0.34). Factor analysis found clusters of descriptors that were significantly associated with WMD grades: “scattered, minimal, tiny, punctate, spotty” with mild (p=0.0001); “multiple, patchy, diffuse” with moderate (p=0.01); and “advanced, confluent, extensive” with severe (p = 0.002).
Discussion: Fazekas terms in clinical radiology reports do not seem to be useful by themselves, but descriptors used in clinical radiology reports may be utilized to approximate PVWMD severity.
- © 2012 by American Heart Association, Inc.