Department of Neurology Mie University Graduate School of Medicine Tsu Mie Japan.
Department of Advanced Diagnostic Imaging Mie University Graduate School of Medicine Tsu Mie Japan.
Brain Behav. 2017 Oct 16;7(11):e00856. doi: 10.1002/brb3.856. eCollection 2017 Nov.
Cerebral microbleeds (CMBs) are often observed in memory clinic patients. It has been generally accepted that deep CMBs (D-CMBs) result from hypertensive vasculopathy (HV), whereas strictly lobar CMBs (SL-CMBs) result from cerebral amyloid angiopathy (CAA) which frequently coexists with Alzheimer's disease (AD). Mixed CMBs (M-CMBs) have been partially attributed to HV and also partially attributed to CAA. The aim of this study was to elucidate the differences between SL-CMBs and M-CMBs in terms of clinical features and regional distribution.
We examined 176 sequential patients in our memory clinic for clinical features and CMB location using susceptibility-weighted images obtained on a 3T-MRI. The number of lobar CMBs in SL-CMBs and M-CMBs was counted in each cerebral lobe and their regional density was adjusted according to the volume of each lobe.
Of the total 176 patients, 111 patients (63.1%) had CMBs. Within the patients who had CMBs, M-CMBs were found in 54 patients (48.6%), followed by SL-CMBs in 35 (31.5%) and D-CMBs in 19 (17.1%). The SL-CMB group showed a significantly higher prevalence of family history of dementia, whereas the M-CMB group showed an increasing trend toward hypertension and smoking. The prevalence of AD was significantly higher in the SL-CMBs group, whereas the prevalence of AD with cerebrovascular disease was higher in the M-CMBs group. The regional density of lobar CMBs was significantly higher in the occipital lobe in the M-CMB group, whereas the SL-CMB group showed higher regional density between regions an increasing tendency in the parietal and occipital lobe.
The between-group differences in clinical features and regional distribution indicate there to be an etiological relationship of SL-CMBs to AD and CAA, and M-CMBs to both HV and CAA.
脑微出血（CMBs）在记忆门诊患者中经常观察到。一般认为深部 CMBs（D-CMBs）是由高血压血管病变（HV）引起的，而严格的皮质下 CMBs（SL-CMBs）是由脑淀粉样血管病（CAA）引起的，CAA 常与阿尔茨海默病（AD）共存。混合性 CMBs（M-CMBs）部分归因于 HV，部分归因于 CAA。本研究旨在阐明 SL-CMBs 和 M-CMBs 在临床特征和区域分布方面的差异。
我们在 3T-MRI 上使用磁敏感加权成像检查了 176 例连续记忆门诊患者的临床特征和 CMB 位置。在 SL-CMBs 和 M-CMBs 中分别计算每个脑叶的皮质下 CMB 数量，并根据每个脑叶的体积调整其区域密度。
在 176 例患者中，111 例（63.1%）有 CMBs。在有 CMBs 的患者中，54 例（48.6%）为 M-CMBs，35 例（31.5%）为 SL-CMBs，19 例（17.1%）为 D-CMBs。SL-CMB 组家族性痴呆病史的患病率明显较高，而 M-CMB 组高血压和吸烟的患病率呈上升趋势。SL-CMB 组 AD 的患病率明显较高，而 M-CMB 组 AD 合并脑血管病的患病率较高。M-CMB 组的皮质下 CMB 区域密度在枕叶明显较高，而 SL-CMB 组在顶叶和枕叶的区域密度呈上升趋势。
组间临床特征和区域分布的差异表明，SL-CMBs 与 AD 和 CAA 有病因关系，M-CMBs 与 HV 和 CAA 都有病因关系。
