From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.
Neurology. 2019 Feb 19;92(8):e774-e781. doi: 10.1212/WNL.0000000000006953. Epub 2019 Jan 23.
To test the hypothesis that patients with concomitant lobar and deep intracerebral hemorrhages/microbleeds (mixed ICH) have predominantly hypertensive small vessel disease (HTN-SVD) rather than cerebral amyloid angiopathy (CAA), using in vivo amyloid imaging.
Eighty Asian patients with primary ICH without dementia were included in this cross-sectional study. All patients underwent brain MRI and C-Pittsburgh compound B (PiB)-PET imaging. The mean cortical standardized uptake value ratio (SUVR) was calculated using cerebellum as reference. Forty-six patients (57.5%) had mixed ICH. Their demographic and clinical profile as well as amyloid deposition patterns were compared to those of 13 patients with CAA-ICH and 21 patients with strictly deep microbleeds and ICH (HTN-ICH).
Patients with mixed ICH were younger (62.8 ± 11.7 vs 73.3 ± 11.9 years in CAA, = 0.006) and showed a higher rate of hypertension than patients with CAA-ICH ( < 0.001). Patients with mixed ICH had lower PiB SUVR than patients with CAA (1.06 [1.01-1.13] vs 1.43 [1.06-1.58], = 0.003). In a multivariable logistic regression model, mixed ICH was associated with hypertension (odds ratio 8.9, 95% confidence interval 1.4-58.4, = 0.02) and lower PiB SUVR (odds ratio 0.03, 95% confidence interval 0.001-0.87, = 0.04) compared to CAA after adjustment for age. Compared to HTN-ICH, mixed ICH showed a similar mean age (62.8 ± 11.7 vs 60.1 ± 14.5 years in HTN-ICH) and risk factor profile (all > 0.1). Furthermore, PiB SUVR did not differ between mixed ICH (values presented above) and HTN-ICH (1.10 [1.00-1.16], = 0.45).
Patients with mixed ICH have much lower amyloid load than patients with CAA-ICH, while being similar to HTN-ICH. Overall, mixed ICH is probably caused by HTN-SVD, an important finding with clinical relevance.
通过体内淀粉样蛋白成像来验证以下假设，即伴有皮质下和深部脑实质血肿/微出血（混合 ICH）的患者主要患有高血压性小血管病（HTN-SVD），而不是脑淀粉样血管病（CAA）。
本横断面研究纳入了 80 名无痴呆的原发性 ICH 亚洲患者。所有患者均接受脑部 MRI 和 C-Pittsburgh 复合 B（PiB）-PET 成像检查。采用小脑作为参照，计算皮质标准化摄取值比值（SUVR）的平均值。46 名患者（57.5%）患有混合 ICH。比较他们的人口统计学和临床特征以及淀粉样蛋白沉积模式与 13 名 CAA-ICH 患者和 21 名严格深部微出血和 ICH（HTN-ICH）患者。
混合 ICH 患者比 CAA 患者年轻（62.8±11.7 岁比 73.3±11.9 岁， = 0.006），并且高血压发生率高于 CAA-ICH 患者（ < 0.001）。与 CAA 患者相比，混合 ICH 患者的 PiB SUVR 较低（1.06[1.01-1.13]比 1.43[1.06-1.58]， = 0.003）。在多变量逻辑回归模型中，与 CAA 相比，混合 ICH 与高血压（比值比 8.9，95%置信区间 1.4-58.4， = 0.02）和较低的 PiB SUVR（比值比 0.03，95%置信区间 0.001-0.87， = 0.04）相关，校正年龄后。与 HTN-ICH 相比，混合 ICH 的平均年龄（62.8±11.7 岁比 HTN-ICH 的 60.1±14.5 岁）和危险因素谱（均 > 0.1）相似。此外，混合 ICH 的 PiB SUVR 与 HTN-ICH 无差异（上述值）（1.10[1.00-1.16]， = 0.45）。
与 CAA-ICH 患者相比，混合 ICH 患者的淀粉样蛋白负荷明显降低，而与 HTN-ICH 患者相似。总体而言，混合 ICH 可能由 HTN-SVD 引起，这一发现具有重要的临床意义。
