Rating scales play an important role in the evaluation of computed tomography (CT) or magnetic resonance-detected white matter lesions (WML). Unfortunately, this type of visual semiquantitative assessment is not yet an optimal tool because commonly agreed concepts regarding its use are lacking. To generate a discussion platform for further improvement of CT and MRI rating, we will provide some basic definitions, summarize the advantages and disadvantages of scoring schemes and review current efforts towards the improvement of this tool. Future research will have to concentrate on deepening our understanding of the histopathologic substrates of WML and on strategies to document their progression.

1.
Hachinski V, Potter P, Merskey H: Leuko-araiosis. Arch Neurol 1987;44:21–23.
2.
Pantoni L, Garcia J: The significance of cerebral white matter abnormalities 100 years after Binswanger’s report: A review. Stroke 1995;26:1293–1301.
3.
Schmidt R, Fazekas F, Offenbacher H, Kapeller P, Schmidt H, Roob G: Prevalence and risk factors for white matter damage; in Fazekas F, Schmidt R, Alavi A (eds): Neuroimaging of Normal Ageing and Uncommon Causes of Dementia. Dordrecht, ICG Publications, 1998, pp 11–25.
4.
Schmidt R, Fazekas F, Kapeller P, Schmidt H, Lechner A: White matter changes and cognitive decline in non-demented subjects; in Leys D, Pasquier F, Scheltens P (eds): Stroke and Alzheimer’s Disease. The Hague, Holland Academic Graphics, 1998, vol 9, pp 174–182.
5.
Scheltens P, Erkinjuntti T, Leys D, et al: White matter changes on CT and MRI: An overview of visual rating scales. Eur Neurol 1998;39:80–89.
6.
Mäntylä R, Erkinjuntti T, Salonen O, et al: Variable agreement between visual rating scales for white matter hyperintensities on MRI. Comparison of 13 rating scales in a poststroke cohort. Stroke 1997;28:1614–1623.
7.
Bokura H, Kobayashi S, Yamaguchi S: Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: A magnetic resonance imaging and pathological study. J Neurol Neurosurg Psychiatry 1998;245:116–122.
8.
Filippi M, Horsfield M, Adèr H, et al: Guidelines for using quantitative measures on brain magnetic resonance imaging abnormalities in monitoring the treatment of multiple sclerosis. Ann Neurol 1998;43:499–506.
9.
Fazekas F, Schmidt R, Scheltens P: Pathophysiologic mechanisms in the development of age-related white matter changes of the brain. Dement Geriatr Cogn Disord 1998;9(suppl 1):2–5.
10.
Van Walderveen M, Kamphorst W, Scheltens P, et al: Histopathologic correlate of hypointense lesions of T1-weighted spin-echo MRI in multiple sclerosis. Neurology 1998;50:1282–1288.
11.
Van Swieten J, Hijdra A, Koudstaal P, van Gijn J: Grading white matter lesions on CT and MRI: A simple scale. J Neurol Neurosurg Psychiatry 1990;53:1080–1083.
12.
Wahlund L, Barkhof F, Fazekas F, et al: A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 2001;32:1318–1322.
13.
Kapeller P, Barber R, Vermeulen J, Schmidt R, Fazekas F, for the European Task Force on Age-Related White Matter Changes: Reliability and validity of different MRI scales for the evaluation of white matter changes. Cerebrovasc Dis 2000;10(suppl 2):28.
14.
Leifer D, Bounnano F, Richardson EJ: Clinicopathologic correlations of cranial magnetic resonance imaging of periventricular white matter. Neurology 1990;40:911–918.
15.
Fazekas F, Kleinert R, Offenbacher H, et al: Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993;43:1683–1689.
16.
Scheltens P, Barkhof F, Leys D, Wolters E, Ravid R, Kamphorst W: Histopathologic correlates of white matter changes on MRI in Alzheimer’s disease and normal aging. Neurology 1995;45:883–888.
17.
Veldink J, Scheltens P, Jonker C, Launer LJ: Progression of cerebral white matter hyperintensities on MRI is related to diastolic blood pressure. Neurology 1998;51:319–320.
18.
Schmidt R, Fazekas F, Kapeller P, Schmidt H, Hartung H: MRI white matter hyperintensities: Three-year follow-up of the Austrian Stroke Prevention Study. Neurology 1999;53:132–139.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.