Bullseye's representation of cerebral white matter hyperintensities

C H Sudre; B Gomez Anson; I Davagnanam; A Schmitt; A F Mendelson; F Prados; L Smith; D Atkinson; A D Hughes; N Chaturvedi; M J Cardoso; F Barkhof; H R Jaeger; S Ourselin

doi:10.1016/j.neurad.2017.10.001

Bullseye's representation of cerebral white matter hyperintensities

J Neuroradiol. 2018 Mar;45(2):114-122. doi: 10.1016/j.neurad.2017.10.001. Epub 2017 Nov 11.

Authors

C H Sudre¹, B Gomez Anson², I Davagnanam³, A Schmitt⁴, A F Mendelson⁵, F Prados⁶, L Smith⁷, D Atkinson⁸, A D Hughes⁹, N Chaturvedi¹⁰, M J Cardoso¹¹, F Barkhof¹², H R Jaeger¹³, S Ourselin¹⁴

Affiliations

¹ Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK. Electronic address: [email protected].
² Santa Creu i Sant Pau Hospital, Universitat Autonòma Barcelona, 08041 Barcelona, Spain. Electronic address: [email protected].
³ Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK. Electronic address: [email protected].
⁴ Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK. Electronic address: [email protected].
⁵ Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK. Electronic address: [email protected].
⁶ Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK. Electronic address: [email protected].
⁷ Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK. Electronic address: [email protected].
⁸ Centre for Medical Imaging, UCL Faculty of Medical Science, NW1 2PG London, UK. Electronic address: [email protected].
⁹ Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK. Electronic address: [email protected].
¹⁰ Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK. Electronic address: [email protected].
¹¹ Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK. Electronic address: [email protected].
¹² Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK. Electronic address: [email protected].
¹³ Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK. Electronic address: [email protected].
¹⁴ Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK. Electronic address: [email protected].

Abstract

Background and purpose: Visual rating scales have limited capacities to depict the regional distribution of cerebral white matter hyperintensities (WMH). We present a regional-zonal volumetric analysis alongside a visualization tool to compare and deconstruct visual rating scales.

Materials and methods: 3D T1-weighted, T2-weighted spin-echo and FLAIR images were acquired on a 3T system, from 82 elderly participants in a population-based study. Images were automatically segmented for WMH. Lobar boundaries and distance to ventricular surface were used to define white matter regions. Regional-zonal WMH loads were displayed using bullseye plots. Four raters assessed all images applying three scales. Correlations between visual scales and regional WMH as well as inter and intra-rater variability were assessed. A multinomial ordinal regression model was used to predict scores based on regional volumes and global WMH burdens.

Results: On average, the bullseye plot depicted a right-left symmetry in the distribution and concentration of damage in the periventricular zone, especially in frontal regions. WMH loads correlated well with the average visual rating scores (e.g. Kendall's tau [Volume, Scheltens]=0.59 CI=[0.53 0.62]). Local correlations allowed comparison of loading patterns between scales and between raters. Regional measurements had more predictive power than global WMH burden (e.g. frontal caps prediction with local features: ICC=0.67 CI=[0.53 0.77], global volume=0.50 CI=[0.32 0.65], intra-rater=0.44 CI=[0.23 0.60]).

Conclusion: Regional-zonal representation of WMH burden highlights similarities and differences between visual rating scales and raters. The bullseye infographic tool provides a simple visual representation of regional lesion load that can be used for rater calibration and training.

Keywords: Ageing; Location; Magnetic resonance imaging; Visual rating scales; White matter hyper intensities.

MeSH terms

Aged
Female
Humans
Imaging, Three-Dimensional
Leukoaraiosis / diagnostic imaging*
Leukoaraiosis / pathology*
Magnetic Resonance Imaging / methods*
Male

Abstract

MeSH terms

Grants and funding