Fazekas-Skala
Fazekas scale
for white matter lesions • Fazekas scale for white matter lesions - Ganzer Fall bei Radiopaedia
Imaging
biomarkers of dementia: recommended visual rating scales with teaching cases. A. Rating of white matter hyperintensities (WMH) according to the Fazekas scale on MRI. Interpretation key. Numbers equal the corresponding image in the supplementary PDF file. a/2) Fazekas 0. Entire cerebrum is without punctate WMH. WMH in the pons and in the cerebellum are not included in the rating – but should be mentioned in the referral. b/19) Fazekas 1. c/14) Fazekas 1. Still punctate WMH. d/15) Fazekas 1. One single lesion < 2 cm and some punctate lesions. e/1) Fazekas 1. Small punctate WMH grouped but separated along the left posterior horn of the lateral ventricle. f/3) Fazekas 1. Grouped but not linked WMH. g/9) Fazekas 1. Many separate WMH. h/12) Fazekas 1. i/18) Fazekas 1. All WMH are seen as separate dots. No connecting bridges. j/17) Fazekas 2, Connecting bridges. k/20) Fazekas 2. Connecting bridges close to the right posterior horn. l/4) Fazekas 2. WMH are linked, but can still be seen as separate lesions. m/7) Fazekas 2. The WMH are beginning to confluate. Individual WMH are still seen. n/13) Fazekas 2. Connecting bridges between lesions. o/10) Fazekas 2. Borderline to Fazekas 3 with bridging between WMH still visible, starting to confluate. p/11) Fazekas 2–3. q/8) Fazekas 3. Borderline Fazekas 2, but the WMH on the left side measures more than 2 cm and grouped WMH are confluent to some extent. r/5) Fazekas 3. s/6) Fazekas 3. Confluent lesions around the frontal horns and confluent thin lesions in the right external capsule, and not so pronounced in the same area on the left side. t/16) Fazekas 3 .B. Rating of white matter hyperintensities (WMH) according to the Fazekas scale on CT. Interpretation key. Numbers equal the corresponding image in the supplementary PDF file. a/2)Fazekas 0–1. No lesions are seen, however punctate lesion may exist. b/7) Fazekas 1. Punctate lesions frontal bilaterally, more obvious right frontal. c/11) Fazekas 1. Lesion in the external capsule bilaterally. d/17) Fazekas 1.Single lesion frontal left. e/15) Fazekas 1. Just small caps around the frontal horns and 2 smaller diffuse punctate lesions in the frontal lobe on the right side. f/20) Fazekas 2. Lesions in the external capsules with connecting bridges. g/3) Fazekas 2. Small lesions close to frontal and posterior horns and small lesions in the external capsules.h/4) Fazekas 2. Small lesions in the external capsule, bilaterally. i/13) Fazekas 2. j/18) Fazekas 2. Lesions in the external capsules. k/12)Fazekas 2–3 depending on the size of the lesions surrounding posterior horns. l/1)Fazekas 3. Confluating lesions around the frontal and posterior horns and in both external capsules.m/5) Fazekas 3.n/6) Fazekas 3. o/8)Fazekas 3. p/9) Fazekas 3. q/10) Fazekas 3. r/14) Fazekas 3. s/19) Fazekas 3. t/16) Fazekas 3
Imaging
biomarkers of dementia: recommended visual rating scales with teaching cases. A. Rating of white matter hyperintensities (WMH) according to the Fazekas scale on MRI. Interpretation key. Numbers equal the corresponding image in the supplementary PDF file. a/2) Fazekas 0. Entire cerebrum is without punctate WMH. WMH in the pons and in the cerebellum are not included in the rating – but should be mentioned in the referral. b/19) Fazekas 1. c/14) Fazekas 1. Still punctate WMH. d/15) Fazekas 1. One single lesion < 2 cm and some punctate lesions. e/1) Fazekas 1. Small punctate WMH grouped but separated along the left posterior horn of the lateral ventricle. f/3) Fazekas 1. Grouped but not linked WMH. g/9) Fazekas 1. Many separate WMH. h/12) Fazekas 1. i/18) Fazekas 1. All WMH are seen as separate dots. No connecting bridges. j/17) Fazekas 2, Connecting bridges. k/20) Fazekas 2. Connecting bridges close to the right posterior horn. l/4) Fazekas 2. WMH are linked, but can still be seen as separate lesions. m/7) Fazekas 2. The WMH are beginning to confluate. Individual WMH are still seen. n/13) Fazekas 2. Connecting bridges between lesions. o/10) Fazekas 2. Borderline to Fazekas 3 with bridging between WMH still visible, starting to confluate. p/11) Fazekas 2–3. q/8) Fazekas 3. Borderline Fazekas 2, but the WMH on the left side measures more than 2 cm and grouped WMH are confluent to some extent. r/5) Fazekas 3. s/6) Fazekas 3. Confluent lesions around the frontal horns and confluent thin lesions in the right external capsule, and not so pronounced in the same area on the left side. t/16) Fazekas 3 .B. Rating of white matter hyperintensities (WMH) according to the Fazekas scale on CT. Interpretation key. Numbers equal the corresponding image in the supplementary PDF file. a/2)Fazekas 0–1. No lesions are seen, however punctate lesion may exist. b/7) Fazekas 1. Punctate lesions frontal bilaterally, more obvious right frontal. c/11) Fazekas 1. Lesion in the external capsule bilaterally. d/17) Fazekas 1.Single lesion frontal left. e/15) Fazekas 1. Just small caps around the frontal horns and 2 smaller diffuse punctate lesions in the frontal lobe on the right side. f/20) Fazekas 2. Lesions in the external capsules with connecting bridges. g/3) Fazekas 2. Small lesions close to frontal and posterior horns and small lesions in the external capsules.h/4) Fazekas 2. Small lesions in the external capsule, bilaterally. i/13) Fazekas 2. j/18) Fazekas 2. Lesions in the external capsules. k/12)Fazekas 2–3 depending on the size of the lesions surrounding posterior horns. l/1)Fazekas 3. Confluating lesions around the frontal and posterior horns and in both external capsules.m/5) Fazekas 3.n/6) Fazekas 3. o/8)Fazekas 3. p/9) Fazekas 3. q/10) Fazekas 3. r/14) Fazekas 3. s/19) Fazekas 3. t/16) Fazekas 3
The Fazekas scale is used to simply quantify the amount of white matter T2 hyperintense lesions usually attributed to chronic small vessel ischemia, although clearly not all such lesions are due to this.
This classification was proposed by Fazekas et al. in 1987 and at the time of writing (late 2016) it remains the most widely used system for describing white matter disease severity in publications. It is not generally used in clinical practice, with terms such as 'mild', 'moderate' and 'severe' being favored.
Classification
The scale divides the white matter in periventricular and deep white matter, and each region is given a grade depending on the size and confluence of lesions .
- periventricular white matter (PVWM)
- 0 = absent
- 1 = “caps” or pencil-thin lining
- 2 = smooth “halo”
- 3 = irregular periventricular signal extending into the deep white matter
- deep white matter (DWM)
- 0 = absent
- 1 = punctate foci
- 2 = beginning confluence
- 3 = large confluent areas
Importantly the etiology of PVWM and DWM changes differ. The latter is chronic small vessel ischemic in nature, whereas the former (periventricular) relates to a combination of demyelination, ependymitis granularis, and subependymal gliosis, as well as small vessel ischemia .
Additionally, it is important to note that it is the deep white matter component score is useful in the assessment of patients with possible dementia (see neurodegenerative MRI brain (an approach)) and it is this component that is usually reported (e.g. "Fazekas grade 2").
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Fazekas-Skala: mikroangiopathische
Leukenzephalopathie
