Let's evaluate white matter hyperintensities (WMHs).
The first patient.
We usually look on Flair, as they show this lesion best.
They are bilateral, almost symmetrical hyperintense areas on T2-weighted and FLAIR images.
We use the Fazekas scale to rate the severity of PVHs and DWMHs, separately.
PVHs seeing as "caps" or pencil-thin lining;
DWMHs appearing as punctate foci;
So both PVH and DWMH score 1.
A second patient. PVHs showed smooth "halo".
DWMHs showed small confluents.
So PVHs scored 2, DWMHs scored 2 as well.
A third patient. Irregular signal extending into the deep white matter
large confluent areas
so the PVH and DWMH score are both 3.
Let's look at other sequences.
here, we have Flair, T2 and T1.
Flair high intensity; T2 high intensity; T1 low intensity
The PVH and DWMH scores are the same for these patients, just for demonstration convenience.
PVH and DWMH often scored different in the same patient.
For example, this patient.
The patient had a PVH score of 3 and a DWMH score of 1.