Abstract
White matter hyperintensities (WMHs) of presumed vascular origin are common in ageing population, especially in patients with acute cerebral infarction and the volume has been reported to be associated with mental impairment and the risk of hemorrhage from antithrombotic agents. WMHs delineation can be computerized to minimize human bias. However, the presence of cerebral infarcts greatly degrades the accuracy of WMHs detection and thus limits the application of computerized delineation to patients with acute cerebral infarction. We propose a computer-assisted segmentation method to depict WMHs in the presence of cerebral infarcts in combined T1-weighted, fluid attenuation inversion recovery, and diffusion-weighted magnetic resonance imaging (MRI). The proposed method detects WMHs by empirical threshold and atlas information, with subtraction of white matter voxels affected by acute infarction. The method was derived using MRI from 25 hemispheres with WMHs only and 13 hemispheres with both WMHs and cerebral infarcts. Similarity index (SI) and correlation were utilized to assess the agreement between the new automated method and a gold standard visually guided semi-automated method done by an expert rater. The proposed WMHs segmentation approach produced average SI, sensitivity and specificity of 83.142±11.742, 84.154±16.086 and 99.988±0.029% with WMHs only and of 68.826±14.036, 74.381±18.473 and 99.956±0.054% with both WMHs and cerebral infarcts in the derivation cohort. The performance of the proposed method with an external validation cohort was also highly consistent with that of the experienced rater.
Highlights
White matter hyperintensities (WMHs), visible in periventricular and subcortical white matter in T2-weighted magnetic resonance imaging (MRI), could be a radiological manifestation in several intracranial diseases, including multiple sclerosis [1], dementia [2], large [3] and small vascular diseases of hypertensive vasculopathy and cerebral amyloid angiopathy [4,5,6,7]
The volumes of WMHs are associated with cognitive impairment in lobar intracerebral hemorrhage (ICH) [5] and the progression of WMHs is associated with cognitive impairment [11] and incident ICH in follow-up [12]
We developed a computer-assisted segmentation method for quantification of WMHs with or without the influence of cerebral infarctions in the T1w, fluid attenuation inversion recovery (FLAIR), and diffusionweighted imaging (DWI) images
Summary
White matter hyperintensities (WMHs), visible in periventricular and subcortical white matter in T2-weighted magnetic resonance imaging (MRI), could be a radiological manifestation in several intracranial diseases, including multiple sclerosis [1], dementia [2], large [3] and small vascular diseases of hypertensive vasculopathy and cerebral amyloid angiopathy [4,5,6,7]. WMHs of presumed vascular origin is one of the neuroimaging features of cerebral small vessels disease, including small subcortical infarcts, lacunes, perivascular spaces microbleeds and brain atrophy [8]. WMHs are common in patients with acute cerebral infarction [8] and its presence increases the risk of stroke, cognitive impairment and death [9]. More severe events of cerebral ischemia were associated with WMHs [10]. Higher burden of WMHs is associated with worse outcomes after ischemic stroke [13]
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