A simplified Fazekas scale for efficient assessment of white matter hyperintensities.
- 1Department of Radiology, Linyi Hospital of Traditional Chinese Medicine, Linyi, China.
Abstract
Background
White matter hyperintensities (WMH) are key neuroimaging markers of cerebral small vessel disease (CSVD) and are associated with neuropsychiatric symptoms in older adults. Although the Fazekas visual rating scale is widely used in research, its clinical adoption remains limited. Therefore, we developed a simplified Fazekas visual rating scale (sFazekas) for overall WMH assessment to facilitate clinical application.Methods
We randomly selected 900 participants from three MRI scanners and evaluated the reliability and scoring efficiency of sFazekas versus the Fazekas scale. Then, all participants were grouped according to the sFazekas scores, and intergroup differences among the different scores were analyzed. Next, we examined correlations among the sFazekas, the Fazekas, and WMH volume. Finally, we explored associations between the sFazekas and vascular risk factors related to CSVD.Results
The sFazekas demonstrated excellent inter-rater reliability (κ = 0.851) and required significantly less time to complete than the conventional Fazekas (p < 0.01). Significant differences in age, WMH volume, and vascular risk factors were observed across sFazekas score groups (p < 0.01). The sFazekas scores were strongly correlated with Fazekas scores for both deep and periventricular white matter, as well as with WMH volume (p < 0.001). Ordinal logistic regression indicated that age, hypertension, diabetes mellitus, and a history of stroke were independent predictors of higher sFazekas scores (p < 0.001).Conclusion
The simplified Fazekas visual rating scale (sFazekas) demonstrates reliability comparable to the conventional Fazekas scale, with the practical advantage of shorter scoring time, suggesting its potential utility in the clinical assessment of overall white matter hyperintensity burden in patients with cerebral small vessel disease.
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BibTeX
@article{liu2026simplified,
title = {{A simplified Fazekas scale for efficient assessment of white matter hyperintensities.}},
author = {Peng Liu and Songguo Liu and Chuanna Xu and Ming Zhu and Xue Liu and Xin Zhao and Bentao Wei and Qiang Li and Guang Han},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1855460},
url = {https://europepmc.org/article/MED/42898175},
note = {CC BY},
}
RIS
TY - JOUR
TI - A simplified Fazekas scale for efficient assessment of white matter hyperintensities.
AU - Peng Liu
AU - Songguo Liu
AU - Chuanna Xu
AU - Ming Zhu
AU - Xue Liu
AU - Xin Zhao
AU - Bentao Wei
AU - Qiang Li
AU - Guang Han
PY - 2026
DA - 2026/10/05
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1855460
UR - https://europepmc.org/article/MED/42898175
AB - Background White matter hyperintensities (WMH) are key neuroimaging markers of cerebral small vessel disease (CSVD) and are associated with neuropsychiatric symptoms in older adults. Although the Fazekas visual rating scale is widely used in research, its clinical adoption remains limited. Therefore, we developed a simplified Fazekas visual rating scale (sFazekas) for overall WMH assessment to facilitate clinical application.Methods We randomly selected 900 participants from three MRI scanners and evaluated the reliability and scoring efficiency of sFazekas versus the Fazekas scale. Then, all participants were grouped according to the sFazekas scores, and intergroup differences among the different scores were analyzed. Next, we examined correlations among the sFazekas, the Fazekas, and WMH volume. Finally, we explored associations between the sFazekas and vascular risk factors related to CSVD.Results The sFazekas demonstrated excellent inter-rater reliability (κ = 0.851) and required significantly less time to complete than the conventional Fazekas (p < 0.01). Significant differences in age, WMH volume, and vascular risk factors were observed across sFazekas score groups (p < 0.01). The sFazekas scores were strongly correlated with Fazekas scores for both deep and periventricular white matter, as well as with WMH volume (p < 0.001). Ordinal logistic regression indicated that age, hypertension, diabetes mellitus, and a history of stroke were independent predictors of higher sFazekas scores (p < 0.001).Conclusion The simplified Fazekas visual rating scale (sFazekas) demonstrates reliability comparable to the conventional Fazekas scale, with the practical advantage of shorter scoring time, suggesting its potential utility in the clinical assessment of overall white matter hyperintensity burden in patients with cerebral small vessel disease.
SN - 1664-2295
ER -