Cerebral Small Vessel Disease Clinical, Neuropsychological, and Radiological Phenotypes, Histopathological Correlates, and Described Genotypes: A Review
Table 3
It depicts different visual scales for CT and MRI which are commonly used.
(a)
Scales for CT white matter changes (WMC)
Assessment of severity
Scores
Van Sweiten et al.
Severity of WMCs on 3 subsequent CT slices is graded separately for the regions anterior and posterior to the central sulcus: 0 = no lesion, 1 = partly involving the white matter, and 2 = extending up to the subcortical region. The scores for the 2 regions have to be added together.
Minimum, 0; maximum, 4
Blennow et al.
Based on extent of WMC 0 = no decrease in the attenuation of white matter; 1 = decreased attenuation of white matter at the margins at the frontal and occipital horns of the lateral ventricles; 2 = decreased attenuation of white matter around the frontal and occipital horns of the lateral ventricles with some extension toward the centrum semiovale; and 3 = decreased attenuation of white matter extending around the whole lateral ventricles and coalescing in the centrum semiovale. Based on severity of WMC 0 = none, 1 = mild, 2 = moderate, and 3 = marked decrease in the attenuation of white matter.
Minimum, 0; maximum, 3 (for extent and severity each)
(b)
Scales for MRI white matter hyperintensities (WMH)
Assessment of severity
Scores
Fazekas et al.
Periventricular and deep WMCs are rated separately. A total score is obtainable by summing the 2 partial scores. Periventricular hyperintensities Scores are as follows: 0 = absence, 1 = “caps” or pencil-thin lining, 2 = smooth “halo,” and 3 = irregular periventricular hyperintensities extending into the deep white matter. Deep white matter hyperintense signals Scores are as follows: 0 = absence, 1 = punctuate foci, 2 = beginning confluence of foci, and 3 = large confluent areas.
Periventricular hyperintensities (minimum, 0; maximum 6) Scoring is as follows: caps, occipital 0/1/2, and frontal 0/1/2; bands, lateral ventricles 0/1/2 (0 = absent, 1 = ≤5 mm, 2 = ≥6 mm, and ≤10 mm). White matter hyperintensities(minimum, 0; maximum, 24) Scoring is as follows: frontal 0/1/2/3/4/5/6, parietal 0/1/2/3/4/5/6, occipital 0/1/2/3/4/5/6, and temporal 0/1/2/3/4/5/6 (0 = no abnormalities; 1 = ≤3 mm, ; 2 = ≤3 mm, ; 3 = 4 to 10 mm, ; 4 = 4 to 10 mm, ; 5 = ≥11 mm, ; 6 = confluent).
Minimum, 0; maximum, 30
Ylikoski et al.
WMCs located at 4 locations (frontal horns, body of the ventricles, trigones, and occipital horns) are rated separately on each hemisphere. Periventricular leukoaraiosis (minimum, 0; maximum, 24) Scoring is as follows: 0 = no hyperintensity; 1 = punctuate, small foci (mild); 2 = cap, pencil-thin lining (moderate); and 3 = nodular band, extending hyperintensity (severe). Centrum semiovale leukoaraiosis, including watershed areas (minimum, 0; maximum, 24) Scoring is as follows: 0 = no hyperintensity; 1 = punctuate, small foci (mild); 2 = beginning confluent (moderate); and 3 = large confluent areas (severe). Total leukoaraiosis score is periventricular leukoaraiosis score plus centrum semiovale leukoaraiosis score equal to 0 to 48.
Minimum, 0; maximum 48
Manolio et al.
Periventricular and subcortical regions are not rated separately. Including 9 grades: 0 = no white matter signal abnormalities; 1 = discontinuous periventricular rim or minimal “dots” of subcortical white matter; 2 = thin, continuous periventricular rim or few patches of subcortical white matter lesions; 3 = thicker continuous periventricular rim with scattered patches of subcortical white matter lesions; 4 = thicker shaggier periventricular rim and mild subcortical white matter lesions and may have minimal confluent periventricular lesions; 5 = mild, periventricular confluence surrounding frontal and occipital horns; 6 = moderate periventricular confluence surrounding frontal and occipital horns; 7 = periventricular confluence with moderate involvement of centrum semiovale; 8 = periventricular confluence involving most of centrum semiovale; and 9 = all white matter involved.
