Abstract
White matter hyperintensities (WMH) are neuroimaging markers linked to an elevated risk of cognitive decline. WMH severity is typically assessed via visual rating scales and through volumetric segmentation. While visual rating scales are commonly used in clinical practice, they offer limited descriptive power. In contrast, supervised volumetric segmentation requires manually annotated masks, which are labor-intensive and challenging to scale for large studies. Therefore, our goal was to develop an automated deep-learning model that can provide accurate and holistic quantification of WMH severity with minimal supervision. We developed WMH-DualTasker, a deep learning model that simultaneously performs voxel-wise segmentation and visual rating score prediction. The model employs self-supervised learning with transformation-invariant consistency constraints, using WMH visual ratings (ARWMC scale, range 0-30) from clinical settings as the sole supervisory signal. Additionally, we assessed its clinical utility by applying it to identify individuals with mild cognitive impairment (MCI) and to predict dementia conversion. The volumetric quantification performance of WMH-DualTasker was either superior to or on par with existing supervised methods, as demonstrated on the MICCAI-WMH dataset (N = 60, Dice = 0.602) and the SINGER dataset (N = 64, Dice = 0.608). Furthermore, the model exhibited strong agreement with clinical visual rating scales on an external dataset (SINGER, MAE = 1.880, K = 0.77). Importantly, WMH severity metrics derived from WMH-DualTasker improved predictive performance beyond conventional clinical features for MCI classification (AUC = 0.718, p < 0.001) and MCI conversion prediction (AUC = 0.652, p < 0.001) using the ADNI dataset. WMH-DualTasker substantially reduces the reliance on labor-intensive manual annotations, facilitating more efficient and scalable quantification of WMH severity in large-scale population studies. This innovative approach has the potential to advance preventive and precision medicine by enhancing the assessment and management of vascular cognitive impairment associated with WMH.