Grading and interpretation of white matter hyperintensities using statistical maps

Wi Sun Ryu, Sung Ho Woo, Dawid Schellingerhout, Moo K. Chung, Chi Kyung Kim, Min Uk Jang, Kyoung Jong Park, Keun Sik Hong, Sang Wuk Jeong, Jeong Yong Na, Ki Hyun Cho, Joon Tae Kim, Beom Joon Kim, Moon Ku Han, Jun Lee, Jae Kwan Cha, Dae Hyun Kim, Soo Joo Lee, Youngchai Ko, Yong Jin ChoByung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Jong Moo Park, Kyusik Kang, Kyung Bok Lee, Tai Hwan Park, Juneyoung Lee, Heung Kook Choi, Kiwon Lee, Hee Joon Bae, Dong Eog Kim

Research output: Contribution to journalArticlepeer-review

48 Citations (Scopus)


Background and Purpose - We aimed to generate rigorous graphical and statistical reference data based on volumetric measurements for assessing the relative severity of white matter hyperintensities (WMHs) in patients with stroke.

Methods - We prospectively mapped WMHs from 2699 patients with first-ever ischemic stroke (mean age=66.8±13.0 years) enrolled consecutively from 11 nationwide stroke centers, from patient (fluid-attenuated-inversion-recovery) MRIs onto a standard brain template set. Using multivariable analyses, we assessed the impact of major (age/hypertension) and minor risk factors on WMH variability.

Results - We have produced a large reference data library showing the location and quantity of WMHs as topographical frequency-volume maps. This easy-to-use graphical reference data set allows the quantitative estimation of the severity of WMH as a percentile rank score. For all patients (median age=69 years), multivariable analysis showed that age, hypertension, atrial fibrillation, and left ventricular hypertrophy were independently associated with increasing WMH (0- 9.4%, median=0.6%, of the measured brain volume). For younger (=69) hypertensives (n=819), age and left ventricular hypertrophy were positively associated with WMH. For older (=70) hypertensives (n=944), age and cholesterol had positive relationships with WMH, whereas diabetes mellitus, hyperlipidemia, and atrial fibrillation had negative relationships with WMH. For younger nonhypertensives (n=578), age and diabetes mellitus were positively related to WMH. For older nonhypertensives (n=328), only age was positively associated with WMH.

Conclusions - We have generated a novel graphical WMH grading (Kim statistical WMH scoring) system, correlated to risk factors and adjusted for age/hypertension. Further studies are required to confirm whether the combined data set allows grading of WMH burden in individual patients and a tailored patient-specific interpretation in ischemic stroke-related clinical practice.

Original languageEnglish
Pages (from-to)3567-3575
Number of pages9
Issue number12
Publication statusPublished - 2014 Dec 11

Bibliographical note

Publisher Copyright:
© 2014 American Heart Association, Inc.


  • Cerebral infarction
  • Leukoaraiosis
  • Magnetic resonance imaging
  • Topographic brain mapping

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing


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