Department of Neurology (E.S.v.E., K.K., S.V., G.M.T., M.J.H.W.), Leiden University Medical Center, Leiden, the Netherlands.
Department of Biomedical Data Sciences (E.W.v.Z.), Leiden University Medical Center, Leiden, the Netherlands.
Stroke. 2020 Dec;51(12):3608-3612. doi: 10.1161/STROKEAHA.120.031264. Epub 2020 Nov 5.
The Edinburgh computed tomography and genetic criteria enable diagnosis of cerebral amyloid angiopathy (CAA) associated lobar intracerebral hemorrhage (ICH) but have not been validated in living patients. We assessed the sensitivity of the Edinburgh criteria in patients with acute lobar ICH due to Dutch-type hereditary CAA; a genetic and pure form of CAA.
We retrospectively analyzed computed tomography-scans from a cohort of consecutive Dutch-type hereditary CAA patients who presented with ≥1 episode(s) of acute lobar ICH at the Leiden University Medical Center. Presence of subarachnoid hemorrhage (SAH) and finger-like projections (FLP) were determined. Association of SAH and FLP with ICH volume was analyzed using multivariate linear regression.
We included 55 Dutch-type hereditary CAA patients (mean age 56 years, 55% men) with a total of 107 episodes of acute lobar ICH. SAH was present in 82/107 (76%) and FLP in 62/107 (58%), resulting in a sensitivity of 76% for SAH and 58% for FLP. In 56 (52%), both markers were present. Nineteen (18%) lobar ICH showed no SAH extension or FLP. ICH volume was significantly associated with presence of SAH (median volume 4 versus 28 mL; =0.001) and presence of FLP (median volume 7 versus 39 mL; <0.001). With an ICH volume of ≥40 mL, the sensitivity of the presence of both SAH and FLP was >81% (95% CI, 70%-92%), whereas in ICH volumes <15 mL the sensitivity was <50%.
The computed tomography-based Edinburgh criteria seem to be a sensitive diagnostic test for CAA-associated lobar ICH, although they should be used with caution in small-sized lobar ICH.
爱丁堡计算机断层扫描和遗传标准可用于诊断与脑淀粉样血管病（CAA）相关的脑叶颅内出血（ICH），但尚未在存活患者中得到验证。我们评估了爱丁堡标准在荷兰型遗传性 CAA 所致急性脑叶 ICH 患者中的敏感性；这是 CAA 的一种遗传和纯形式。
我们回顾性分析了莱顿大学医学中心连续就诊的荷兰型遗传性 CAA 患者队列的计算机断层扫描图像，这些患者因急性脑叶 ICH 发作≥1 次。确定蛛网膜下腔出血（SAH）和指状突起（FLP）的存在。使用多元线性回归分析 SAH 和 FLP 与 ICH 体积的相关性。
我们纳入了 55 例荷兰型遗传性 CAA 患者（平均年龄 56 岁，55%为男性），共有 107 例急性脑叶 ICH 发作。107 例 ICH 中有 82 例（76%）存在 SAH，62 例（58%）存在 FLP，SAH 的敏感性为 76%，FLP 的敏感性为 58%。在 56 例（52%）患者中，两种标志物均存在。19 例（18%）脑叶 ICH 未见 SAH 延伸或 FLP。ICH 体积与 SAH 的存在显著相关（中位数体积 4 与 28 毫升；=0.001）和 FLP 的存在显著相关（中位数体积 7 与 39 毫升；<0.001）。当 ICH 体积≥40 毫升时，同时存在 SAH 和 FLP 的敏感性>81%（95%CI，70%-92%），而 ICH 体积<15 毫升时的敏感性<50%。
基于计算机断层扫描的爱丁堡标准似乎是一种针对 CAA 相关脑叶 ICH 的敏感诊断测试，但在小体积脑叶 ICH 中应谨慎使用。
