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Neuroradiology
Demonstration data

Fazekas Scale

Grading of white-matter hyperintensities on MRI, reflecting the burden of small-vessel disease.

The Fazekas scale grades white-matter hyperintensities on T2/FLAIR MRI separately for the periventricular and deep white matter, each on a 0–3 scale, providing a semi-quantitative measure of cerebral small-vessel disease.

🧮 Interactive Calculator

📐 Formula

Periventricular grade + deep white-matter grade (each 0–3)

When to Use

  • Reporting white-matter hyperintensities on brain MRI.
  • Estimating the burden of chronic small-vessel ischaemic disease.
  • Longitudinal follow-up of leukoaraiosis.

How It Works

  • Periventricular: 0 absent, 1 caps/pencil-thin lining, 2 smooth halo, 3 irregular signal extending into deep white matter.
  • Deep white matter: 0 absent, 1 punctate foci, 2 beginning confluence, 3 large confluent areas.
  • The two component grades are reported; their sum (0–6) gives an overall burden.

Interpreting the Result

  • Combined 0–2 — mild small-vessel disease burden.
  • Combined 3–4 — moderate burden.
  • Combined 5–6 — severe, confluent small-vessel disease.
  • A deep white-matter grade of 3 (confluent) is the strongest correlate of clinical small-vessel disease.

Limitations & Pitfalls

  • Semi-quantitative and reader-dependent, particularly at the confluence thresholds.
  • Does not localise or distinguish aetiologies of white-matter change.
  • Correlation with cognition is imperfect at lower grades.

References

  • Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987;149(2):351-356.
  • Wahlund LO, Barkhof F, Fazekas F, et al. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2001;32(6):1318-1322.

⚕️ For clinical decision support only. Always verify calculations and apply clinical judgment.