Fazekas scale: Meaning in a Radiology Report

The Fazekas scale grades white matter bright spots on brain MRI from 0 to 3, from none to large merged areas.

What it means

The Fazekas scale grades white matter hyperintensities. These are bright spots in the white matter, the brain's wiring, on T2 and FLAIR MRI images. Grade 0 means none, 1 small separate spots, 2 spots beginning to join, and 3 large merged areas. Some reports give two grades: one for the white matter next to the fluid spaces (ventricles), and one for the deeper white matter.

When it matters

Grade 1 is very common with age and often causes no symptoms. Grades 2 and 3 usually reflect more small vessel disease, wear of tiny brain arteries linked to high blood pressure, diabetes, smoking and age. Higher grades are linked over time with a greater risk of stroke, memory problems and balance trouble. Your doctor may review blood pressure and other risk factors. In younger people, other causes such as migraine or multiple sclerosis may be considered.

Questions to ask your doctor

What is my Fazekas grade, and is it usual for my age?
Has the grade changed compared with my earlier MRI?
Which of my risk factors, such as blood pressure, could be contributing?

General information, not medical advice. What a finding means for you depends on your symptoms, your history and the images themselves, so talk your results through with a doctor.