biostudies-literatureRahmani Mthe James S. McDonnell FoundationMcDonnell Center for Systems NeuroscienceNIA NIH HHSBarnes-Jewish Hospital Foundation1310-1322https://www.ebi.ac.uk/biostudies/studies/S-EPMC11582091biostudies-literatureUnknown18(5)This systematic review examines the prevalence, underlying mechanisms, cohort characteristics, evaluation criteria, and cohort types in white matter hyperintensity (WMH) pipeline and implementation literature spanning the last two decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we categorized WMH segmentation tools based on their methodologies from January 1, 2000, to November 18, 2022. Inclusion criteria involved articles using openly available techniques with detailed descriptions, focusing on WMH as a primary outcome. Our analysis identified 1007 visual rating scales, 118 pipeline development articles, and 509 implementation articles. These studies predominantly explored aging, dementia, psychiatric disorders, and small vessel dBrain imaging and behaviorEvolution of white matter hyperintensity segmentation methods and implementation over the past two decades; an incomplete shift towards deep learning.PMC11582091U24 AG072122Shishegar RBurnham SO'Brien ECognitionHarari OFedyashov VVlassenko AGMarcus DPorter TDore VRowe CImagingVillemagne VFowler CArtificial Intelligence and Machine LearningStrain JFGeneticsLee JMCoxDoecke TJLaws SPerrin RXia YGoyal MSBiostats, Database and BioinformaticsRahmani MCerebrovascular Disease (CVD) RiskHippocampal Sclerosis (HS-TDP43) RiskBateman RSohrabi HJack CCSF and BloodLuckett PHCruchaga CMartins RLi STosun DXiong CAschenbrenner AMussoumzadeh PWomack KKukull WBourgeat PNeuropathologyMaruff PSaykin ADierker DDIANYassi NLi QXMorris JYaeger LOwens CMayo CJRaniga PShaw LFripp JADOPIC, ADNI InvestigatorsHassenstab JJafri HMasters CLWeiner MMcDade ESchindler SMorris JCGoudey BRoberts BNACCRobertson JLim YYBenzinger TLSMarkovic SfalseEvolution of white matter hyperintensity segmentation methods and implementation over the past two decades; an incomplete shift towards deep learning.This systematic review examines the prevalence, underlying mechanisms, cohort characteristics, evaluation criteria, and cohort types in white matter hyperintensity (WMH) pipeline and implementation literature spanning the last two decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we categorized WMH segmentation tools based on their methodologies from January 1, 2000, to November 18, 2022. Inclusion criteria involved articles using openly available techniques with detailed descriptions, focusing on WMH as a primary outcome. Our analysis identified 1007 visual rating scales, 118 pipeline development articles, and 509 implementation articles. These studies predominantly explored aging, dementia, psychiatric disorders, and small vessel d2024-01-01T00:00:00Z2024 Oct2025-04-04T13:41:25.119Z2025-04-04T13:41:25.119ZS-EPMC115820913908314410.1007/s11682-024-00902-w