Grading and interpretation of white matter hyperintensities using statistical maps

Wi-Sun Ryu¹, Sung-Ho Woo¹, Dawid Schellingerhout¹, Moo K Chung¹, Chi Kyung Kim¹, Min Uk Jang¹, Kyoung-Jong Park¹, Keun-Sik Hong¹, Sang-Wuk Jeong¹, Jeong-Yong Na¹, Ki-Hyun Cho¹, Joon-Tae Kim¹, Beom Joon Kim¹, Moon-Ku Han¹, Jun Lee¹, Jae-Kwan Cha¹, Dae-Hyun Kim¹, Soo Joo Lee¹, Youngchai Ko¹, Yong-Jin Cho¹, Byung-Chul Lee¹, Kyung-Ho Yu¹, Mi-Sun Oh¹, Jong-Moo Park¹, Kyusik Kang¹, Kyung Bok Lee¹, Tai Hwan Park¹, Juneyoung Lee¹, Heung-Kook Choi¹, Kiwon Lee¹, Hee-Joon Bae², Dong-Eog Kim²

Affiliations

¹ From the Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Korea (W.-S.R., S.-H.W., S.-W.J., J.-Y.N., D.-E.K.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston (D.S.); Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison (M.K.C.); WeBace Co, Ltd, Busan, Korea (K.-J.P.); Department of Neurology, Seoul National University Hospital, Seoul, Korea (C.K.K.); Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, Korea (M.U.J.); Department of Neurology, Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., J.-T.K.); Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.); Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.); Department of Neurology, Eulji University Hospital, Daejeon, Korea (S.J.L., Y.K.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.); Department of Neurology, Eulji General Hospital, Seoul, Korea (J.-M.P., K.K.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.); Department of Neurology, Seoul Medical Center, Seoul, Korea (T.H.P.); Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (J.L.); Department of Computer Science, Inje University, Busan, Korea (H.-K.C.); and Departments of Neurology and Neurosurgery, The University of Texas Health Science Center, Houston (K.L.).
² From the Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Korea (W.-S.R., S.-H.W., S.-W.J., J.-Y.N., D.-E.K.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston (D.S.); Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison (M.K.C.); WeBace Co, Ltd, Busan, Korea (K.-J.P.); Department of Neurology, Seoul National University Hospital, Seoul, Korea (C.K.K.); Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, Korea (M.U.J.); Department of Neurology, Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., J.-T.K.); Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.); Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.); Department of Neurology, Eulji University Hospital, Daejeon, Korea (S.J.L., Y.K.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.); Department of Neurology, Eulji General Hospital, Seoul, Korea (J.-M.P., K.K.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.); Department of Neurology, Seoul Medical Center, Seoul, Korea (T.H.P.); Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (J.L.); Department of Computer Science, Inje University, Busan, Korea (H.-K.C.); and Departments of Neurology and Neurosurgery, The University of Texas Health Science Center, Houston (K.L.). kdongeog@duih.org braindoc@snu.ac.kr.

PMID: 25388424
DOI: 10.1161/STROKEAHA.114.006662

Multicenter Study

Grading and interpretation of white matter hyperintensities using statistical maps

Wi-Sun Ryu et al. Stroke. 2014 Dec.

. 2014 Dec;45(12):3567-75.

doi: 10.1161/STROKEAHA.114.006662. Epub 2014 Nov 11.

Authors

Affiliations

¹ From the Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Korea (W.-S.R., S.-H.W., S.-W.J., J.-Y.N., D.-E.K.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston (D.S.); Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison (M.K.C.); WeBace Co, Ltd, Busan, Korea (K.-J.P.); Department of Neurology, Seoul National University Hospital, Seoul, Korea (C.K.K.); Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, Korea (M.U.J.); Department of Neurology, Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., J.-T.K.); Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.); Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.); Department of Neurology, Eulji University Hospital, Daejeon, Korea (S.J.L., Y.K.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.); Department of Neurology, Eulji General Hospital, Seoul, Korea (J.-M.P., K.K.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.); Department of Neurology, Seoul Medical Center, Seoul, Korea (T.H.P.); Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (J.L.); Department of Computer Science, Inje University, Busan, Korea (H.-K.C.); and Departments of Neurology and Neurosurgery, The University of Texas Health Science Center, Houston (K.L.).
² From the Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Korea (W.-S.R., S.-H.W., S.-W.J., J.-Y.N., D.-E.K.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston (D.S.); Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison (M.K.C.); WeBace Co, Ltd, Busan, Korea (K.-J.P.); Department of Neurology, Seoul National University Hospital, Seoul, Korea (C.K.K.); Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, Korea (M.U.J.); Department of Neurology, Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., J.-T.K.); Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.); Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.); Department of Neurology, Eulji University Hospital, Daejeon, Korea (S.J.L., Y.K.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.); Department of Neurology, Eulji General Hospital, Seoul, Korea (J.-M.P., K.K.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.); Department of Neurology, Seoul Medical Center, Seoul, Korea (T.H.P.); Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (J.L.); Department of Computer Science, Inje University, Busan, Korea (H.-K.C.); and Departments of Neurology and Neurosurgery, The University of Texas Health Science Center, Houston (K.L.). kdongeog@duih.org braindoc@snu.ac.kr.

PMID: 25388424
DOI: 10.1161/STROKEAHA.114.006662

Erratum in

Correction.
[No authors listed] [No authors listed] Stroke. 2015 Sep;46(9):e223. doi: 10.1161/STR.0000000000000078. Stroke. 2015. PMID: 26304870 No abstract available.

Abstract

Background and purpose: We aimed to generate rigorous graphical and statistical reference data based on volumetric measurements for assessing the relative severity of white matter hyperintensities (WMHs) in patients with stroke.

Methods: We prospectively mapped WMHs from 2699 patients with first-ever ischemic stroke (mean age=66.8±13.0 years) enrolled consecutively from 11 nationwide stroke centers, from patient (fluid-attenuated-inversion-recovery) MRIs onto a standard brain template set. Using multivariable analyses, we assessed the impact of major (age/hypertension) and minor risk factors on WMH variability.

Results: We have produced a large reference data library showing the location and quantity of WMHs as topographical frequency-volume maps. This easy-to-use graphical reference data set allows the quantitative estimation of the severity of WMH as a percentile rank score. For all patients (median age=69 years), multivariable analysis showed that age, hypertension, atrial fibrillation, and left ventricular hypertrophy were independently associated with increasing WMH (0-9.4%, median=0.6%, of the measured brain volume). For younger (≤69) hypertensives (n=819), age and left ventricular hypertrophy were positively associated with WMH. For older (≥70) hypertensives (n=944), age and cholesterol had positive relationships with WMH, whereas diabetes mellitus, hyperlipidemia, and atrial fibrillation had negative relationships with WMH. For younger nonhypertensives (n=578), age and diabetes mellitus were positively related to WMH. For older nonhypertensives (n=328), only age was positively associated with WMH.

Conclusions: We have generated a novel graphical WMH grading (Kim statistical WMH scoring) system, correlated to risk factors and adjusted for age/hypertension. Further studies are required to confirm whether the combined data set allows grading of WMH burden in individual patients and a tailored patient-specific interpretation in ischemic stroke-related clinical practice.

Keywords: cerebral infarction; leukoaraiosis; magnetic resonance imaging; topographic brain mapping.

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Grading and interpretation of white matter hyperintensities using statistical maps

Affiliations

Grading and interpretation of white matter hyperintensities using statistical maps

Authors

Affiliations

Erratum in

Abstract

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