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From the Departments of Epidemiology & Biostatistics (Drs. Prins, van Dijk, and Breteler), Neurology (Drs. Prins, van Dijk, and Koudstaal), and Medical Informatics and Radiology (Dr. Vrooman), Erasmus Medical Center, Rotterdam; Department of Neurology and Alzheimer Center (Drs. van Straaten and Scheltens) and Department of Radiology and Image Analysis Center (R.A. van Schijndel and Dr. Barkhof), VU Medical Center, Amsterdam, the Netherlands; and Department of Neurologic and Psychiatric Sciences (Dr. Simoni), University of Florence, Italy.
Address correspondence and reprint requests to Dr. M.M.B. Breteler, Department of Epidemiology & Biostatistics, Erasmus Medical Center, PO Box 1738, 3000 DR Rotterdam, the Netherlands; e-mail: m.breteler{at}erasmusmc.nl
Objective: To evaluate the concordance of a volumetric method for measuring white matter lesion (WML) change with visual rating scales.
Methods: The authors selected a stratified sample of 20 elderly people (mean age 72 years, range 61 to 88 years) with an MRI examination at baseline and at 3-year follow-up from the community-based Rotterdam Scan Study (RSS). Four raters assessed WML change with four different visual rating scales: the Fazekas scale, the Scheltens scale, the RSS scale, and a new visual rating scale that was designed to measure change in WML. The authors assessed concordance with a volumetric method with scatter plots and correlations, and interobserver agreement with intraclass correlation coefficients.
Results: For assessment of change in WML, the Fazekas, Scheltens, and periventricular part of the RSS scale showed little correlation with volumetrics, and low interobserver agreement. The authors’ new WML change scale and the subcortical part of the RSS scale showed good correlation with volumetrics. After additional training, the new WML change scale showed good interobserver agreement for measuring WML change.
Conclusions: Commonly used visual rating scales are not well suited for measuring change in white matter lesion severity. The authors’ new white matter lesion change scale is more accurate and precise, and may be of use in studies focusing on progression of white matter lesions.
Received May 27, 2003. Accepted in final form December 1, 2003.
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