From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (A.C., G.B., L.X., M.P., D.R., A.A., K.M.S., J.R., M.E.G., A.V., S.M.G.).
Division of Neurology, Faculty of Medicine, Department of Medicine, Naresuan University, Phitsanulok, Thailand (D.R.).
Stroke. 2019 Apr;50(4):954-962. doi: 10.1161/STROKEAHA.118.023368.
Background and Purpose- We investigated cortical superficial siderosis (cSS) progression and its clinical relevance for incident lobar intracerebral hemorrhage (ICH) risk, in probable cerebral amyloid angiopathy presenting with neurological symptoms and without ICH at baseline. Methods- Consecutive patients meeting modified Boston criteria for probable cerebral amyloid angiopathy from a single-center cohort who underwent magnetic resonance imaging (MRI) at baseline and during follow-up were analyzed. cSS progression was assessed by comparison of the baseline and follow-up images. Patients were followed prospectively for incident symptomatic ICH. cSS progression and first-ever ICH risk were investigated in Cox proportional hazard models adjusting for confounders. Results- The cohort included 118 probable cerebral amyloid angiopathy patients: 72 (61%) presented with transient focal neurological episodes and 46 (39%) with cognitive complaints prompting the baseline MRI investigation. Fifty-two patients (44.1%) had cSS at baseline. During a median scan interval of 2.2 years (interquartile range, 1.2-4.4 years) between the baseline (ie, first) MRI and the latest MRI, cSS progression was detected in 33 (28%) patients. In multivariable logistic regression, baseline cSS presence (odds ratio, 4.04; 95% CI, 1.53-10.70; P=0.005), especially disseminated cSS (odds ratio, 9.12; 95% CI, 2.85-29.18; P<0.0001) and appearance of new lobar microbleeds (odds ratio, 4.24; 95% CI, 1.29-13.9; P=0.017) were independent predictors of cSS progression. For patients without an ICH during the interscan interval (n=105) and subsequent follow-up (median postfinal MRI time, 1.34; interquartile range, 0.3-3 years), cSS progression independently predicted increased symptomatic ICH risk (hazard ratio, 3.76; 95% CI, 1.37-10.35; P=0.010). Conclusions- Our results suggest that cSS evolution may be a useful biomarker for assessing disease progression and ICH risk in cerebral amyloid angiopathy patients and a candidate biomarker for clinical studies and trials.
背景与目的- 我们研究了皮质浅层铁沉积（cSS）的进展及其对无基线脑出血（ICH）的可能脑淀粉样血管病患者发生脑叶 ICH 风险的临床相关性。方法- 对来自单中心队列的符合改良波士顿标准的可能脑淀粉样血管病患者连续进行分析，这些患者在基线和随访期间进行了磁共振成像（MRI）检查。通过比较基线和随访图像评估 cSS 进展。前瞻性随访患者发生症状性 ICH 的情况。在调整混杂因素的 Cox 比例风险模型中，研究了 cSS 进展和首次 ICH 风险。结果- 该队列包括 118 例可能脑淀粉样血管病患者：72 例（61%）表现为短暂性局灶性神经发作，46 例（39%）表现为认知障碍促使进行基线 MRI 检查。52 例（44.1%）基线时存在 cSS。在基线（即首次）MRI 和最新 MRI 之间的中位扫描间隔 2.2 年（四分位距，1.2-4.4 年）期间，33 例（28%）患者检测到 cSS 进展。在多变量逻辑回归中，基线时存在 cSS（优势比，4.04；95%置信区间，1.53-10.70；P=0.005），尤其是弥散性 cSS（优势比，9.12；95%置信区间，2.85-29.18；P<0.0001）和新出现的脑叶微出血（优势比，4.24；95%置信区间，1.29-13.9；P=0.017）是 cSS 进展的独立预测因素。对于在扫描间隔期间（n=105）和随后随访期间（末次 MRI 后中位数时间，1.34；四分位距，0.3-3 年）无 ICH 的患者，cSS 进展独立预测症状性 ICH 风险增加（危险比，3.76；95%置信区间，1.37-10.35；P=0.010）。结论- 我们的研究结果表明，cSS 演变可能是评估脑淀粉样血管病患者疾病进展和 ICH 风险的有用生物标志物，也是临床研究和试验的候选生物标志物。
