ADD-ONS / SCALES
FAZEKAS scale
Created 25/11/2021, last revision 18/01/2023
- proposed by Fazekas in 1987 (Fazekas, 1987)
- the most widely used scale designed for simple quantification of white matter lesions (WML), often resulting from arteriolosclerosis (arteriolopathy)
- 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 diabetes
- arteriolosclerosis must be distinguished from arteriosclerosis (hardening of medium or large arteries) and atherosclerosis (hardening due to atheromatous plaques)
- in routine practice, the scale is often replaced by the terms mild, moderate, and severe to describe the severity of lesions
- the scale distinguishes 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 assessed 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
- 0 = no lesion
- 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
