A new classification system for ischemia using a combination of deep and periventricular white matter hyperintensities

J Stroke Cerebrovasc Dis. 2014 Apr;23(4):636-42. doi: 10.1016/j.jstrokecerebrovasdis.2013.06.002. Epub 2013 Jul 16.


The Clinical Research Center for Dementia of South Korea (CREDOS) group developed a new classification system for ischemia using a combination of deep and periventricular white matter hyperintensities (WMHs). In this study, we aimed to evaluate the validity of the CREDOS ischemia classification system. A total of 352 patients with cognitive impairments were included. Their WMH scores were rated using the CREDOS WMH visual rating scale. These patients were divided into 3 groups according to the CREDOS ischemia classification system. The volume of WMH was also automatically measured. The number of lacunes and microbleeds (MBs) were counted. The CREDOS ischemia classification system was revised with factor analysis using vascular risk factors and cerebrovascular disease (CVD) markers (WMH volume, lacunes, and MBs). External validation was performed in another group of patients with cognitive impairment using multinomial logistic regression analysis. The CREDOS WMH visual rating scale showed excellent correlation with the automatically measured volume of WMH. The factor analysis showed that the severe group was expanded to D3P1 and D3P2 in the revised CREDOS ischemia classification system. In the validation group, the presence of vascular risk factors and the severity of CVD markers could be distinguished according to the revised CREDOS ischemia classification. We validated a newly developed classification system for ischemia. This simple visual classification system was capable of providing information on vascular risk factors and CVD markers by simply rating WMH on magnetic resonance imaging.

Keywords: White matter hyperintensities; cerebrovascular disease; classification; ischemia; magnetic resonance imaging; visual rating.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain / pathology*
  • Brain Ischemia / classification*
  • Brain Ischemia / pathology
  • Cerebral Ventricles / pathology*
  • Cohort Studies
  • Dementia / classification
  • Dementia / pathology
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / classification
  • Infarction, Middle Cerebral Artery / pathology
  • Magnetic Resonance Imaging
  • Male
  • Neuropsychological Tests
  • Reproducibility of Results
  • Risk Factors