This pilot study examined the reproducibility of serial magnetic resonance (MR) measurements of brain, ventricular, sulcal, and lesion volumes in patients with ischemic brain disease using an image analysis protocol designed at the University of Cincinnati. Five patients with a clinical history of brain ischemia had two separate MR brain imaging studies using the standard clinical MR imaging protocol at the University of Cincinnati Medical Center. The MR images on both film and tape were digitized and then analyzed according to the standardized image analysis protocol. Based on tape data, variability in volume measurements between the two MR studies, as measured by the coefficient of variation, ranged from 1% for intracranial volume to 8% for ventricular volume. Variability based on film data was slightly greater, ranging from 2% for intracranial volume to 12% for lesion volume. As part of a multicenter treatment trial of vascular dementia, this method was then used to analyze MR films in 13 patients with vascular dementia who all had an MR study at baseline and at 1 year. The mean annual change in lesion volume was 4 +/- 5 cm3 (a 24% increase from the baseline lesion volume); in ventricular volume, 7 +/- 8 cm3 (a 10% increase from baseline); and in sulcal volume, 13 +/- 25 cm3 (a 5% increase from baseline). This method of image analysis, using MR film or tape-generated data, can provide reproducible serial measurements of brain, ventricular, sulcal, and ischemic lesion volumes. This method, if applied in randomized treatment trials of vascular dementia or multiple sclerosis, can be used to monitor disease progression and to evaluate the effectiveness of a given therapy.