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J Stroke Cerebrovasc Dis. 2014 Apr;23(4):636-42. doi: 10.1016/j.jstrokecerebrovasdis.2013.06.002. Epub 2013 Jul 16.

A new classification system for ischemia using a combination of deep and periventricular white matter hyperintensities.

Author information

1
Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea.
2
Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea; Institute on Aging, Ajou University Medical Center, Suwon, Korea. Electronic address: yhlee@ajou.ac.kr.
3
Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. Electronic address: sangwonseo@empal.com.
4
Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
5
Department of Neurology, Inha University College of Medicine, Incheon, Korea.
6
Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea; Institute on Aging, Ajou University Medical Center, Suwon, Korea.
7
Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Korea.
8
Medical Affairs, Pfizer Korea, Seoul, Korea.
9
Department of Psychology, University of Cambridge, Cambridge, UK.
10
Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
11
Department of Biomedical Engineering, Hanyang University, Seoul, Korea.
12
Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea.
13
Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
14
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
15
Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
16
Department of Neurology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea.
17
Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.

Abstract

The Clinical Research Center for Dementia of South Korea (CREDOS) group developed a new classification system for ischemia using a combination of deep and periventricular white matter hyperintensities (WMHs). In this study, we aimed to evaluate the validity of the CREDOS ischemia classification system. A total of 352 patients with cognitive impairments were included. Their WMH scores were rated using the CREDOS WMH visual rating scale. These patients were divided into 3 groups according to the CREDOS ischemia classification system. The volume of WMH was also automatically measured. The number of lacunes and microbleeds (MBs) were counted. The CREDOS ischemia classification system was revised with factor analysis using vascular risk factors and cerebrovascular disease (CVD) markers (WMH volume, lacunes, and MBs). External validation was performed in another group of patients with cognitive impairment using multinomial logistic regression analysis. The CREDOS WMH visual rating scale showed excellent correlation with the automatically measured volume of WMH. The factor analysis showed that the severe group was expanded to D3P1 and D3P2 in the revised CREDOS ischemia classification system. In the validation group, the presence of vascular risk factors and the severity of CVD markers could be distinguished according to the revised CREDOS ischemia classification. We validated a newly developed classification system for ischemia. This simple visual classification system was capable of providing information on vascular risk factors and CVD markers by simply rating WMH on magnetic resonance imaging.

KEYWORDS:

White matter hyperintensities; cerebrovascular disease; classification; ischemia; magnetic resonance imaging; visual rating

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