Dement Neurocogn Disord.  2013 Mar;12(1):21-28. 10.12779/dnd.2013.12.1.21.

A Semi-Automated Method for Measuring White Matter Hyperintensity Volume

• Shim Y
• Yoon B
• Hong YJ
• Cho AH
• Yang DW

• KMID: 2222357
• DOI: http://doi.org/10.12779/dnd.2013.12.1.21

Abstract

BACKGROUND
White matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) have been considered as a reliable biomarker of small vessel damages. To evaluate the severity of WMHs, it is vital to develop reliable methods to measure the volume of WMHs. We applied open source software to measure WMH volume in the semi-automated way, and tested the reliability and validity by comparing with the commonly used qualitative rating scale.
METHODS
Twenty five subjects with variable WMHs were recruited. ANALYZE 10.0 was used for the image processing and volumetric measurement of WMHs. The inhomogeneity and artifacts of signal were corrected with Insight Segmentation and Registration Toolkit in ANALYZE. For the gold standard of the WMH volumetric measurement, threshold method was applied with consensus of manual editing on each slice of the MRI images by two raters. Histogram of the all slices of the Fluid Attenuated Inversion Recovery (FLAIR) MRI was generated to calculate the optimal voxel intensity of threshold, and the lowest voxel threshold was decided as the mean+1.4 SD. The volumes of WMHs were generated by multiplying the area and the thickness of each slice. Inter- and intrarater reliability of the semi-automated volumetric and Scheltens'methods, and the association between the individual methods were analyzed.
RESULTS
The semi-automated WMH volume at the threshold of 1.4 SD as well as the gold standard volume was well correlated with the Scheltens' visual scale (r=0.75, p<0.001). The semi-automated volumetry showed the excellent intra-rater (ICC=0.9929; 95% CI, 0.9840-0.9968) and inter-rater reliability (ICC=0.9830; 95% CI, 0.9620-0.9925), superior to the Scheltens' visual rating scale.
CONCLUSIONS
The semi-automated volume measurement of the WMHs with Analyze was a valid and a reliable method to quantify subcortical white matter damages of various etiologies.

Keyword

White matter hyperintensities; Magnetic resonance imaging; Semi-automated quantification

MeSH Terms

Artifacts
Consensus
Glycosaminoglycans
Humans
Magnetic Resonance Imaging
Reproducibility of Results
Glycosaminoglycans

Figure

• 

  Fig. 1 Volumetric process of white matter hyperintensities (WMHs). (A) DICOM files of Fluid Attenuated Inversion Recovery image were converted to Analyze files by using the MRIcro software. (B) Images before and after the Inhomogeneity Correction and (C) image after the skull and the soft tissue were removed manually were shown. (D) After measuring voxel intensity with histogram, (E) WMHs were selected with threshold method. (F) Image of region of interest selection was acquired and volumes of total WMHs were generated by multiplying the area and the thickness of each slice. Green color means areas of WMHs measured in the study, but areas of red color were excluded in the study analysis.

• 

  Fig. 2 Correlation of the Scheltens' visual rating scale with the semi-automated volumetric measurements including the gold standard volume and the volume at the threshold of 1.4 SD. The mean rating of Scheltens' visual scales was correlated with both mean volumes of the gold standard method and at the threshold of 1.4 SD (r=0.75, p<0.001). GS, gold standard volume; 1.4 SD, volume at the threshold of 1.4 SD; VRS, visual rating scale by the Scheltens' method.

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