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We visually rated silent cerebral lesion (SCLs) in Osirix DICOM Viewer Lite (Pixmeo SARL, Swiss, https://www.osirix-viewer.com)

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First, we import the data, anonymize the subjects' information with a key in the tool bar.

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We have pre-removed the subjects' identity information.

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Now, we start the evaluation of the silent lacunes (SLs).

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This work is mainly done on the T1 horizontal images.

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Here's a suggestion, that the evaluators develop their habits of evaluating in a fixed order.

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I always evaluate in the order of “the frontal lobe - island lobe - basal ganglion - thalamus - temporal lobe - parietal lobe - occipital lobe - cerebellum - brain stem”.

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We evaluate two hemispheres separately. Complete all the evaluation of one side, then the other.

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Visually scan each area 2 times. This effectively avoids omissions. 

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Here's a demonstration. I'll start with the frontal lobe on the right

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Positioned to the bottom of the frontal lobe and began to glance up

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layer by layer, up to the top.(speed up)

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and then scan the frontal lobe across all the layers once more, from top to bottom.

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After complete with the frontal lobe, we go on with the assessment of the island lobe.

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Again, from bottom to top, and then once more from top to bottom.

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Then, evaluates the rest of the right brain.

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Then, continue with the left side.

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In the course of scanning, if a suspicious lesion is found

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Mark it with this dot marking tool.(speed up)

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If more than one suspicious lesions are found, make multiple markers.

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When all areas have been assessed and lesions have been marked

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 further explore each suspicious lesion one by one.

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Open new sequences with right-click on the left panel.

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Choose a windows tiling mode

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Replace a repeating T2 window with Flair.

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So that I can make a comparison.

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On Flair and T1, lacunes are hypointense foci of 2-15 mm diameter. 

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On T2, they are hyperintense.