Bullseye's representation of cerebral white matter hyperintensities

C. H. Sudre, B. Gomez Anson, I. Davagnanam, A. Schmitt, A. F. Mendelson, F. Prados, L. Smith, D. Atkinson, A. D. Hughes, N. Chaturvedi, M. J. Cardoso, F. Barkhof, H. R. Jaeger, S. Ourselin

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23 Citations (Scopus)


Background and purpose: Visual rating scales have limited capacities to depict the regional distribution of cerebral white matter hyperintensities (WMH). We present a regional-zonal volumetric analysis alongside a visualization tool to compare and deconstruct visual rating scales. Materials and methods: 3D T1-weighted, T2-weighted spin-echo and FLAIR images were acquired on a 3 T system, from 82 elderly participants in a population-based study. Images were automatically segmented for WMH. Lobar boundaries and distance to ventricular surface were used to define white matter regions. Regional-zonal WMH loads were displayed using bullseye plots. Four raters assessed all images applying three scales. Correlations between visual scales and regional WMH as well as inter and intra-rater variability were assessed. A multinomial ordinal regression model was used to predict scores based on regional volumes and global WMH burdens. Results: On average, the bullseye plot depicted a right-left symmetry in the distribution and concentration of damage in the periventricular zone, especially in frontal regions. WMH loads correlated well with the average visual rating scores (e.g. Kendall's tau [Volume, Scheltens] = 0.59 CI = [0.53 0.62]). Local correlations allowed comparison of loading patterns between scales and between raters. Regional measurements had more predictive power than global WMH burden (e.g. frontal caps prediction with local features: ICC = 0.67 CI = [0.53 0.77], global volume = 0.50 CI = [0.32 0.65], intra-rater = 0.44 CI = [0.23 0.60]). Conclusion: Regional-zonal representation of WMH burden highlights similarities and differences between visual rating scales and raters. The bullseye infographic tool provides a simple visual representation of regional lesion load that can be used for rater calibration and training.

Original languageEnglish
Pages (from-to)114-122
Number of pages9
JournalJournal of Neuroradiology
Issue number2
Publication statusPublished - 1 Mar 2018


  • Ageing
  • Location
  • Magnetic resonance imaging
  • Visual rating scales
  • White matter hyper intensities

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