Sunday, 23 October 2011

Grading small vessel disease

Fazeka's classification is used for grading of changes of small vessel disease.
MR is more sensitive and specific compared to CT, Axial FLAIR is enough.

Fazekas I : Mild, few small punctate lesions in the deep white matter.
Fazekas II : Moderate; larger WMLs that are beginning to become confluent.
Fazekas III : Severe; confluent T2 hyper intensity.

Grade i or Mild:

Grade ii or Moderate:

Grade iii or Severe:

Fazekas I is considered normal in aging after 40.
Fazekas II is considered abnormal in patients < 75 Years.
Fazekas III is abnormal in any age group and indicate poor control over diabetes and hypertension.

3 comments:

Anonymous said...

nice information at the end...saw case of fazeka III case last wk..sandeep garg

Anonymous said...

hi nice to see this images
i have some dout
1.grade iii requires T2 imaging always or T1 also we can grade .
2.difference between demylinating vs wml IN reference to T2 wt imaging ?
Dr Nilesh cahudhary

Dr Balaji Anvekar said...

T1w images are of no use. T2 / FLAIR is must.
Demyelinating lesions vs Small vessel disease.
1. age of pt.
2. Location of lesion and appearance.Lesions involving corpus callosum, callaso septal groove, T2 shine through of lesions, orientation perpendicular to ependymal lining, posterior fossa lesions in cerebellum goes in favor of Demyelinating lesion, an associated cord lesion.