Created 25/11/2021, last revision 31/08/2022

  • proposed by Fazekas in 1987  (Fazekas, 1987)
  • most widely used scale designed for simple quantification of white matter lesions (WML), often resulting from arteriolosclerosis (arteriolopathy)  Arteriolosclerosis

    • arteriolosclerosis involves hardening and loss of elasticity of arterioles or small arteries
    • it includes hyaline arteriolosclerosis and hyperplastic arteriolosclerosis, both leading to luminal narrowing and is often associated with hypertension and DM
    • arteriolosclerosis must be distinguished from arteriosclerosis (hardening of medium or large arteries) and atherosclerosis (hardening due to atheromatous plaque)
  • in routine practice, it is often replaced by the qualifiers mild, moderate, and severe to describe the severity of the lesions
  • the scale differentiates two regions of white matter:
    • periventricular white matter (PVWM)
    • deep white matter (DWM)
  • each region is assessed in terms of the number, size, and confluence of  lesions
  • it is best scored on transverse FLAIR or T2-weighted MRI
  • periventricular white matter lesions (PVWM) are not always of an ischemic origin (demyelination, subependymal gliosis, ependymitis, etc.)
    • 0 = no lesion
    • 1 = “caps” or pencil-thin lining
    • 2 = smooth “halo”
    • 3 = irregular periventricular signal extending into the deep white matter
  • therefore, only deep white matter (DWM) is assessed when monitoring vascular changes i.e., FAZEKAS 0-3
    • 0 = no lesion
    • 1 = punctate lesions
    • 2 = beginning confluence
    • 3 = extensive confluent areas


Fazekas 3

ARWMC (Age Related White Matter Changes) scale
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