Bullseye's representation of cerebral white matter hyperintensities

C. H. Sudre*, B. Gomez Anson, I. Davagnanam, A. Schmitt, A. F. Mendelson, F. Prados, L. Smith, D. Atkinson, A. D. Hughes, N. Chaturvedi, M. J. Cardoso, F. Barkhof, H. R. Jaeger, S. Ourselin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Background and purpose: Visual rating scales have limited capacities to depict the regional distribution of cerebral white matter hyperintensities (WMH). We present a regional-zonal volumetric analysis alongside a visualization tool to compare and deconstruct visual rating scales. Materials and methods: 3D T1-weighted, T2-weighted spin-echo and FLAIR images were acquired on a 3 T system, from 82 elderly participants in a population-based study. Images were automatically segmented for WMH. Lobar boundaries and distance to ventricular surface were used to define white matter regions. Regional-zonal WMH loads were displayed using bullseye plots. Four raters assessed all images applying three scales. Correlations between visual scales and regional WMH as well as inter and intra-rater variability were assessed. A multinomial ordinal regression model was used to predict scores based on regional volumes and global WMH burdens. Results: On average, the bullseye plot depicted a right-left symmetry in the distribution and concentration of damage in the periventricular zone, especially in frontal regions. WMH loads correlated well with the average visual rating scores (e.g. Kendall's tau [Volume, Scheltens] = 0.59 CI = [0.53 0.62]). Local correlations allowed comparison of loading patterns between scales and between raters. Regional measurements had more predictive power than global WMH burden (e.g. frontal caps prediction with local features: ICC = 0.67 CI = [0.53 0.77], global volume = 0.50 CI = [0.32 0.65], intra-rater = 0.44 CI = [0.23 0.60]). Conclusion: Regional-zonal representation of WMH burden highlights similarities and differences between visual rating scales and raters. The bullseye infographic tool provides a simple visual representation of regional lesion load that can be used for rater calibration and training.

Original languageEnglish
Pages (from-to)114-122
Number of pages9
JournalJournal of Neuroradiology
Issue number2
Early online date11 Nov 2017
Publication statusPublished - 1 Mar 2018


  • Ageing
  • Location
  • Magnetic resonance imaging
  • Visual rating scales
  • White matter hyper intensities


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