RT Journal Article
SR Electronic
T1 Definitions of white matter hyperintensity change: impact on estimates of progression and regression
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP svn-2024-003300
DO 10.1136/svn-2024-003300
A1 Jochems, Angela C C
A1 Muñoz Maniega, Susana
A1 Clancy, Una
A1 Arteaga Reyes, Carmen
A1 Jaime Garcia, Daniela
A1 Valdés Hernández, Maria del C.
A1 Chappell, Francesca M
A1 Barclay, Gayle
A1 Jardine, Charlotte
A1 McIntyre, Donna
A1 Gerrish, Iona
A1 Wiseman, Stewart
A1 Stringer, Michael S
A1 Thrippleton, Michael J
A1 Doubal, Fergus
A1 Wardlaw, Joanna M
YR 2024
UL http://svn.bmj.com/content/early/2024/10/02/svn-2024-003300.abstract
AB Background White matter hyperintensity (WMH) progression is well documented; WMH regression is more contentious, which might reflect differences in defining WMH change. We compared four existing WMH change definitions in one population to determine the effect of definition on WMH regression.Methods We recruited patients with minor non-disabling ischaemic stroke who underwent MRI 1–3 months after stroke and 1 year later. We assessed WMH volume (in absolute mL and % intracranial volume) and applied four different definitions, including two thresholds (based on SD or mL), percentile and quintile approaches.Results In 198 participants, mean age 65.5 (SD=11.13), baseline WMH volume was 15.46 mL (SD=19.2), the mean net WMH volume change was 0.98 mL (SD=2.84), range −7.98 to +12.84 mL. Proportion regressing/stable/progressing WMH were threshold 1 (SD), 29.8%/55.6%/14.6%; threshold 2(mL), 29.8%/16.7%/53.5%; percentile approach, 28.3%/21.2%/50.5%. The quintile approach includes five groups with quintile 3 reflecting no change (N=40), quintiles 1 and 2 any WMH decrease (N=80) and quintiles 4 and 5 any WMH increase (N=78).Conclusions Different WMH change definitions cause big differences in how participants are categorised; additionally, non-normal WMH distribution precludes use of some definitions. Consistent use of an appropriate definition would facilitate data comparisons, particularly in clinical trials of potential WMH treatments.