Sharma Rohit, Dearaugo Stephanie, Infeld Bernard, O'Sullivan Richard, Gerraty Richard P
Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia.
Epworth HealthCare, Richmond, Victoria, Australia.
J Med Imaging Radiat Oncol. 2018 Mar 31. doi: 10.1111/1754-9485.12726.
Cerebral amyloid angiopathy (CAA) is an important cause of lobar intracerebral haemorrhage (ICH) in the elderly, but has other clinico-radiological manifestations. In the last two decades, certain magnetic resonance imaging (MRI) sequences, namely gradient-recalled echo imaging and the newer and more sensitive susceptibility-weighted imaging, have been utilised to detect susceptibility-sensitive lesions such as cerebral microbleeds and cortical superficial siderosis. These can be utilised sensitively and specifically by the Modified Boston Criteria to make a diagnosis of CAA without the need for 'gold-standard' histopathology from biopsy. However, recently, other promising MRI biomarkers of CAA have been described which may further increase precision of radiological diagnosis, namely chronic white matter ischaemia, cerebral microinfarcts and lobar lacunes, cortical atrophy, and increased dilated perivascular spaces in the centrum semiovale. However, the radiological manifestations of CAA, as well as their clinical correlates, may have other aetiologies and mimics. It is important for the radiologist to be aware of these clinico-radiological features and mimics to accurately diagnose CAA. This is increasingly important in a patient demographic that has a high prevalence for use of antiplatelet and antithrombotic medications for other comorbidities which inherently carries an increased risk of ICH in patients with CAA.
脑淀粉样血管病（CAA）是老年人脑叶脑出血（ICH）的重要病因，但还有其他临床放射学表现。在过去二十年中，某些磁共振成像（MRI）序列，即梯度回波成像以及更新且更敏感的磁敏感加权成像，已被用于检测磁敏感病变，如脑微出血和皮质表面铁沉积。通过改良波士顿标准可以敏感且特异地利用这些表现来诊断CAA，而无需活检的“金标准”组织病理学检查。然而，最近又描述了其他有前景的CAA的MRI生物标志物，它们可能会进一步提高放射学诊断的准确性，即慢性白质缺血、脑微梗死和脑叶腔隙、皮质萎缩以及半卵圆中心扩张的血管周围间隙增加。然而，CAA的放射学表现及其临床关联可能有其他病因及类似表现。放射科医生了解这些临床放射学特征及类似表现对于准确诊断CAA很重要。在因其他合并症而大量使用抗血小板和抗血栓药物的患者群体中，这一点愈发重要，因为这些药物本身会增加CAA患者发生ICH的风险。
