Grading of white-matter hyperintensities on MRI, reflecting the burden of small-vessel disease.
The Fazekas scale grades white-matter hyperintensities on T2/FLAIR MRI separately for the periventricular and deep white matter, each on a 0–3 scale, providing a semi-quantitative measure of cerebral small-vessel disease.
🧮 Interactive Calculator
📐 Formula
Periventricular grade + deep white-matter grade (each 0–3)
🎯 When to Use
Reporting white-matter hyperintensities on brain MRI.
Estimating the burden of chronic small-vessel ischaemic disease.
Longitudinal follow-up of leukoaraiosis.
⚙️ How It Works
Periventricular: 0 absent, 1 caps/pencil-thin lining, 2 smooth halo, 3 irregular signal extending into deep white matter.
Deep white matter: 0 absent, 1 punctate foci, 2 beginning confluence, 3 large confluent areas.
The two component grades are reported; their sum (0–6) gives an overall burden.
A deep white-matter grade of 3 (confluent) is the strongest correlate of clinical small-vessel disease.
⚠️ Limitations & Pitfalls
Semi-quantitative and reader-dependent, particularly at the confluence thresholds.
Does not localise or distinguish aetiologies of white-matter change.
Correlation with cognition is imperfect at lower grades.
📚 References
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987;149(2):351-356.
Wahlund LO, Barkhof F, Fazekas F, et al. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2001;32(6):1318-1322.
⚕️ For clinical decision support only. Always verify calculations and apply clinical judgment.