The ARWMC Rating Scale

David Goldemund M.D.
Updated on 22/03/2024, published on 25/04/2023

ARWMC (Age-Related White Matter Changes)

  • this scale was designed to evaluate white matter changes (WMCs) on either CT or MRI scans
    • sensitivity and reliability are higher with MRI
    • differences between MRI and CT in the detection of WMCs are primarily related to lesion size –  MRI is better at detecting small lesions, while medium and large lesions are equally well visualized by both modalities
    • regional differences play a minor role, as ARWMC lesions occur in areas that can usually be imaged with high quality by both MRI and CT
  • WMCs definition:
    • T2 or FLAIR MRI images – bright (hyperintense) lesions ≥ 5 mm
    • NCCT – hypodense areas ≥ 5 mm
  • the following areas are scored (each hemisphere separately):
    • frontal
    • parieto-occipital
    • temporal
    • infratentorial, including the cerebellum
    • basal ganglia (striatum, globus pallidus, thalamus, internal and external capsule, and insula)
White matter lesions (WML)
0 no lesion (including symmetrical, well-defined caps or bands)
1 focal lesions
2 an incipient confluence of lesions
3 diffuse involvement of the entire region, with or without U-fibers involvement
Basal ganglia lesions
0 no lesion
1 1 focal lesion  (≥ 5 mm)
2 > 1 focal lesion
3 confluent lesions
ARWMC scale - white matter lesions
ARWMC scale - basal ganglia lesions

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The ARWMC Rating Scale