Visual rating versus volumetric segmentation of white matter hyperintensities for cognitive assessment: a memory clinic-based comparison and systematic review.
4 affiliations
- 1Dept. of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
- 2Dept. of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
- 3Dept. of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
- 4Dept. of Geriatrics and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Abstract
Introduction
Clinical impression of WMH commonly relies on visual rating scales (VRS), yet may improve through volumetric segmentation. Comparative studies, particularly considering clinical outcomes, are scarce.Methods
We conducted a retrospective, cross-sectional study among 246 memory clinic patients. We compared WMH assessed through VRS (Fazekas) to automated volumetric segmentation (Quantib), through correlation and explained variance in neuropsychological assessment across six cognitive domains, above and beyond age, sex, and educational attainment in linear regression models. Results were contextualised through systematic literature review until 30 September 2022.Results
Fazekas scores and WMH volumes were strongly correlated in the memory clinic population (ρ=0.83, p < 0.001), with little overlap in volumes between Fazekas categories. This was supported by similar correlations observed in 24 studies included in the systematic review and 13 in meta-analysis. Jointly with demographics, VRS and segmentation explained 6-19% of variance in cognitive domains in the memory clinic population. Volumetrics explained at most 2% more variance than visual rating, most substantial in MMSE (2%), in contrast to executive function (-1%). The systematic review identified three other comparative studies on cognitive outcome, each reporting similar correlations with volumetrics and visual rating scales. Previously proposed cut-offs in WMH volume that approximate Fazekas categories (3.4, 9.6 and 17.1 mL) showed classification accuracies of 59%, 70% and 78% in our cohort, with optimal thresholds in our sample at 1.6, 6.0 and 19.8 mL.Discussion
VRS and volumetric segmentation of WMH are highly correlated. Small improvements in explained variance in cognition with volumetrics were inconsistent across cognitive domains.
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BibTeX
@article{dijk2026visual,
title = {{Visual rating versus volumetric segmentation of white matter hyperintensities for cognitive assessment: a memory clinic-based comparison and systematic review.}},
author = {Geke G C E A van Dijk and Camiel V J Box and Farog Faghir and Joy Martens and Janne M Papma and Francesco U S Mattace Raso and Esther Van Den Berg and Meike W Vernooij and Frank J Wolters},
journal = {Cerebral circulation - cognition and behavior},
year = {2026},
month = oct,
doi = {10.1016/j.cccb.2026.100564},
url = {https://europepmc.org/article/MED/42898208},
note = {CC BY},
}
RIS
TY - JOUR
TI - Visual rating versus volumetric segmentation of white matter hyperintensities for cognitive assessment: a memory clinic-based comparison and systematic review.
AU - Geke G C E A van Dijk
AU - Camiel V J Box
AU - Farog Faghir
AU - Joy Martens
AU - Janne M Papma
AU - Francesco U S Mattace Raso
AU - Esther Van Den Berg
AU - Meike W Vernooij
AU - Frank J Wolters
PY - 2026
DA - 2026/10/03
JO - Cerebral circulation - cognition and behavior
DO - 10.1016/j.cccb.2026.100564
UR - https://europepmc.org/article/MED/42898208
AB - Introduction Clinical impression of WMH commonly relies on visual rating scales (VRS), yet may improve through volumetric segmentation. Comparative studies, particularly considering clinical outcomes, are scarce.Methods We conducted a retrospective, cross-sectional study among 246 memory clinic patients. We compared WMH assessed through VRS (Fazekas) to automated volumetric segmentation (Quantib), through correlation and explained variance in neuropsychological assessment across six cognitive domains, above and beyond age, sex, and educational attainment in linear regression models. Results were contextualised through systematic literature review until 30 September 2022.Results Fazekas scores and WMH volumes were strongly correlated in the memory clinic population (ρ=0.83, p < 0.001), with little overlap in volumes between Fazekas categories. This was supported by similar correlations observed in 24 studies included in the systematic review and 13 in meta-analysis. Jointly with demographics, VRS and segmentation explained 6-19% of variance in cognitive domains in the memory clinic population. Volumetrics explained at most 2% more variance than visual rating, most substantial in MMSE (2%), in contrast to executive function (-1%). The systematic review identified three other comparative studies on cognitive outcome, each reporting similar correlations with volumetrics and visual rating scales. Previously proposed cut-offs in WMH volume that approximate Fazekas categories (3.4, 9.6 and 17.1 mL) showed classification accuracies of 59%, 70% and 78% in our cohort, with optimal thresholds in our sample at 1.6, 6.0 and 19.8 mL.Discussion VRS and volumetric segmentation of WMH are highly correlated. Small improvements in explained variance in cognition with volumetrics were inconsistent across cognitive domains.
SN - 2666-2450
ER -