The simplified Fazekas visual rating scale (sFazekas) demonstrates reliability comparable to the conventional Fazekas scale, with the practical advantage of shorter scoring time, suggesting its potential utility in the clinical assessment of overall white matter hyperintensity burden in patients with cerebral small vessel disease.
The sFazekas showed excellent inter-rater reliability for assessing overall WMH burden.
The sFazekas required significantly less scoring time than the conventional Fazekas scale.
Age, WMH volume, and vascular risk factors differed significantly across sFazekas score groups.
sFazekas scores were strongly correlated with conventional Fazekas scores and with WMH volume.
Age, hypertension, diabetes mellitus, and history of stroke were independent predictors of higher sFazekas scores.
The authors developed sFazekas to address limited clinical adoption of the Fazekas scale, providing a single overall WMH assessment.
White matter hyperintensities are bright spots seen on brain MRI scans that are linked to small blood vessel disease in the brain and to mood and thinking problems in older adults. The Fazekas scale is a common way to rate them visually, but it is used mostly in research and less in everyday clinical practice. The researchers created a simplified version, called sFazekas, that gives a single overall score for the burden of these spots. Using MRI scans from 900 people across three scanners, they found that two raters agreed with each other very well using the simplified scale, and that it took significantly less time than the standard scale. Its scores matched closely with the standard Fazekas scores for both deep and periventricular white matter, and with measured volume of the hyperintensities. Higher scores were linked to older age, high blood pressure, diabetes, and previous stroke. This research suggests that a quicker rating method could make it easier to assess white matter changes in routine care without losing much reliability. The findings come from a single study, and the authors suggest the scale's potential use in clinical assessment rather than showing that it improves patient outcomes.
Liu P, Liu S, Xu C, Zhu M, Liu X, Zhao X, et al.. (2026). A simplified Fazekas scale for efficient assessment of white matter hyperintensities.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1855460