IMR Press / JIN / Volume 22 / Issue 3 / DOI: 10.31083/j.jin2203057
Open Access Original Research
A Fully Automated Visual Grading System for White Matter Hyperintensities of T2-Fluid Attenuated Inversion Recovery Magnetic Resonance Imaging
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1 Research Institute, NEUROPHET Inc., 06234 Seoul, Republic of Korea
2 Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 06247 Seoul, Republic of Korea
3 Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 06247 Seoul, Republic of Korea
4 Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 06247 Seoul, Republic of Korea
*Correspondence: jeeyoungkim@catholic.ac.kr (JeeYoung Kim)
These authors contributed equally.
J. Integr. Neurosci. 2023, 22(3), 57; https://doi.org/10.31083/j.jin2203057
Submitted: 30 September 2022 | Revised: 21 December 2022 | Accepted: 26 December 2022 | Published: 6 May 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: The Fazekas scale is one of the most commonly used visual grading systems for white matter hyperintensity (WMH) for brain disorders like dementia from T2-fluid attenuated inversion recovery magnetic resonance (MR) images (T2-FLAIRs). However, the visual grading of the Fazekas scale suffers from low-intra and inter-rater reliability and high labor-intensive work. Therefore, we developed a fully automated visual grading system using quantifiable measurements. Methods: Our approach involves four stages: (1) the deep learning-based segmentation of ventricles and WMH lesions, (2) the categorization into periventricular white matter hyperintensity (PWMH) and deep white matter hyperintensity (DWMH), (3) the WMH diameter measurement, and (4) automated scoring, following the quantifiable method modified for Fazekas grading. We compared the performances of our method and that of the modified Fazekas scale graded by three neuroradiologists for 404 subjects with T2-FLAIR utilized from a clinical site in Korea. Results: The Krippendorff’s alpha across our method and raters (A) versus those only between the radiologists (R) were comparable, showing substantial (0.694 vs. 0.732; 0.658 vs. 0.671) and moderate (0.579 vs. 0.586) level of agreements for the modified Fazekas, the DWMH, and the PWMH scales, respectively. Also, the average of areas under the receiver operating characteristic curve between the radiologists (0.80 ± 0.09) and the radiologists against our approach (0.80 ± 0.03) was comparable. Conclusions: Our fully automated visual grading system for WMH demonstrated comparable performance to the radiologists, which we believe has the potential to assist the radiologist in clinical findings with unbiased and consistent scoring.

Keywords
Fazekas scale
white matter lesion hyperintensity
T2-FLAIR
deep-learning
brain segmentation
Funding
202015X34/Korea Medical Device Development Fund
KMDF-PR-20200901-0306/Korea Medical Device Development Fund
Figures
Fig. 1.
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