# Fazekas — Fazekas visual rating of periventricular and deep white matter hyperintensities

> Two separate 0-3 MRI ratings for periventricular and deep white matter hyperintensity burden. Preserve both raw scores and lesion pattern: Fazekas is a burden descriptor, not an etiologic diagnosis, dementia biomarker, individual-risk calculator or grade-only treatment rule.

**Situação:** vigente · **Órgão:** Encéfalo · **Órgão emissor:** Fazekas et al. / STRIVE · **Versão:** 1987 original two-axis scale; STRIVE-2 terminology and 2023 incidental-WMH care context · **Ano:** 1987

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI
- Fonte primária: Fazekas F, Chawluk JB, Alavi A, et al.. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging (1987) — https://doi.org/10.2214/ajr.149.2.351
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Return the two original location-specific ratings. A single number is acceptable only when its external protocol and aggregation rule are named and both raw axes remain available.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 0 | Score 0, absent on the rated axis | Rate each original axis separately. Periventricular WMH score 0 means no periventricular hyperintensity; deep WMH score 0 means no deep white-matter hyperintense focus. Do not substitute one undifferentiated global score for the two raw ratings. | No treatment or follow-up action follows from a score of 0. If neurologic symptoms or another imaging abnormality is present, evaluate that problem on its own merits; absence of WMH does not close the clinical differential. | This is the no-burden reference state for the rated axis, not proof of neurologic health and not a calibrated probability of future stroke, cognitive decline, gait impairment or dementia. | Fazekas et al., AJR 1987;149:351-356, PMID 3496763, original separate periventricular and deep WMH ratings; Ottavi et al., Med J Aust 2023;219:278-284, DOI 10.5694/mja2.52079, Box 3 and consensus recommendations for the grade-independent incidental-WMH care boundary. | ✓ |
| 1 | Score 1, caps or thin lining / punctate deep foci | Rate each axis separately. Periventricular score 1 is caps or a pencil-thin lining around the ventricles; deep score 1 is punctate foci. Record both raw scores even when a local protocol also reports their maximum as a summary. | For an incidental typical WMH pattern, review neurologic-event history and cardiovascular risks such as blood pressure, diabetes, lipids and smoking, then manage identified risks under usual guidance. Do not start aspirin, anticoagulation or a statin solely for this grade. | A small punctate burden can be common with increasing age and is nonspecific. The original small cohort found punctate or early confluent deep lesions in both Alzheimer and control participants, so grade 1 does not establish vascular or neurodegenerative etiology. | Fazekas et al., AJR 1987, PMID 3496763, abstract and original morphology definitions; Wardlaw et al., STRIVE, PMC3714437, WMH terminology; Ottavi et al. 2023, DOI 10.5694/mja2.52079, consensus recommendations on cardiovascular screening and against antiplatelet or anticoagulant use solely for incidental WMH. | ✓ |
| 2 | Score 2, smooth halo / beginning deep confluence | Rate each axis separately. Periventricular score 2 is a smooth halo; deep score 2 is beginning or early confluence of previously punctate foci. A smooth halo is not the irregular deep extension of periventricular score 3. | Correlate moderate burden with age, symptoms, lesion distribution, comparison studies and vascular risks. Address identified risks using standard clinical guidance and assess an atypical pattern or unexplained symptoms separately; the score alone does not determine medication, referral or MRI interval. | More extensive WMH burden is associated at population level with adverse neurologic and functional outcomes, but no current source supplies a transportable individual probability for score 2. Etiology and prognosis still depend on pattern and clinical context. | Fazekas et al., AJR 1987, PMID 3496763, separate periventricular halo and deep beginning-confluence definitions; Duering et al., STRIVE-2 2023, DOI 10.1016/S1474-4422(23)00131-X, current small-vessel-disease imaging context; Ottavi et al. 2023, DOI 10.5694/mja2.52079, grade-independent care recommendations. | ✓ |
| 3 | Score 3, irregular periventricular extension / large deep confluence | Rate each axis separately. Periventricular score 3 is irregular hyperintensity extending into adjacent deep white matter; deep score 3 is large confluent areas. State which axis is 3 rather than reporting severe Fazekas disease without location. | Integrate confluent burden with age, symptoms, gait or cognitive concerns, longitudinal change and other small-vessel-disease markers. Optimize confirmed cardiovascular risks and seek neurologic assessment for rapidly progressive, unexplained or radiologically atypical findings; never prescribe from grade 3 alone. | Confluent WMH represents the greatest burden on the rated axis and is associated with worse outcomes at population level. It is not a diagnosis of dementia, not proof of vascular cause and not an individualized forecast of stroke, cognitive decline or mortality. | Fazekas et al., AJR 1987, PMID 3496763, original irregular periventricular extension and confluent deep-WMH definitions; Wardlaw et al., STRIVE, PMC3714437, and Duering et al., STRIVE-2, DOI 10.1016/S1474-4422(23)00131-X, terminology and interpretation; Ottavi et al. 2023, DOI 10.5694/mja2.52079, incidental-WMH management and referral context. | ✓ |

### Citações por categoria
- **0**: Fazekas F, Chawluk JB, Alavi A, et al.. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging (1987) — https://doi.org/10.2214/ajr.149.2.351 · Fazekas et al., AJR 1987;149:351-356, PMID 3496763, original separate periventricular and deep WMH ratings; Ottavi et al., Med J Aust 2023;219:278-284, DOI 10.5694/mja2.52079, Box 3 and consensus recommendations for the grade-independent incidental-WMH care boundary.
- **1**: Fazekas F, Chawluk JB, Alavi A, et al.. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging (1987) — https://doi.org/10.2214/ajr.149.2.351 · Fazekas et al., AJR 1987, PMID 3496763, abstract and original morphology definitions; Wardlaw et al., STRIVE, PMC3714437, WMH terminology; Ottavi et al. 2023, DOI 10.5694/mja2.52079, consensus recommendations on cardiovascular screening and against antiplatelet or anticoagulant use solely for incidental WMH.
- **2**: Fazekas F, Chawluk JB, Alavi A, et al.. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging (1987) — https://doi.org/10.2214/ajr.149.2.351 · Fazekas et al., AJR 1987, PMID 3496763, separate periventricular halo and deep beginning-confluence definitions; Duering et al., STRIVE-2 2023, DOI 10.1016/S1474-4422(23)00131-X, current small-vessel-disease imaging context; Ottavi et al. 2023, DOI 10.5694/mja2.52079, grade-independent care recommendations.
- **3**: Fazekas F, Chawluk JB, Alavi A, et al.. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging (1987) — https://doi.org/10.2214/ajr.149.2.351 · Fazekas et al., AJR 1987, PMID 3496763, original irregular periventricular extension and confluent deep-WMH definitions; Wardlaw et al., STRIVE, PMC3714437, and Duering et al., STRIVE-2, DOI 10.1016/S1474-4422(23)00131-X, terminology and interpretation; Ottavi et al. 2023, DOI 10.5694/mja2.52079, incidental-WMH management and referral context.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2023-09-18 | revised | STRIVE-2 updated small-vessel-disease imaging terminology and the Medical Journal of Australia consensus supplied incidental-WMH care context. Neither source replaced the original Fazekas category map or converted it into a treatment scale. | confirmed |
| 1987-08-01 | published | Fazekas scale described in AJR. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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