Schwarz Ghil, Banerjee Gargi, Hostettler Isabel C, Ambler Gareth, Seiffge David J, Ozkan Hatice, Browning Simone, Simister Robert, Wilson Duncan, Cohen Hannah, Yousry Tarek, Al-Shahi Salman Rustam, Lip Gregory Y H, Brown Martin M, Muir Keith W, Houlden Henry, Jäger Rolf, Werring David J
Stroke Research Centre, Institute of Neurology, University College London, London, UK.
Department of Neurology and Stroke Unit ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Int J Stroke. 2023 Jan;18(1):85-94. doi: 10.1177/17474930211062478. Epub 2022 Jan 7.
Cerebral amyloid angiopathy (CAA), a common cause of intracerebral hemorrhage (ICH), is diagnosed using the Boston criteria including magnetic resonance imaging (MRI) biomarkers (cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS). The simplified Edinburgh criteria include computed tomography (CT) biomarkers (subarachnoid extension (SAE) and finger-like projections (FLPs)). The underlying mechanisms and diagnostic accuracy of CT compared to MRI biomarkers of CAA are unknown.
We included 140 survivors of spontaneous lobar supratentorial ICH with both acute CT and MRI. We assessed associations between MRI and CT biomarkers and the diagnostic accuracy of CT- compared to MRI-based criteria.
FLPs were more common in patients with strictly lobar CMB (44.7% vs 23.5%; p = 0.014) and SAE was more common in patients with cSS (61.3% vs 31.2%; p = 0.002). The high probability of the CAA category of the simplified Edinburgh criteria showed 87.2% (95% confidence interval (CI): 78.3-93.4) specificity, 29.6% (95% CI: 18.0-43.6) sensitivity, 59.3% (95% CI: 38.8-77.6) positive predictive value, and 66.4% (95%: CI 56.9-75.0) negative predictive value, 2.3 (95% CI: 1.2-4.6) positive likelihood ratio and 0.8 (95% CI 0.7-1.0) negative likelihood ratio for probable CAA (vs non-probable CAA), defined by the modified Boston criteria; the area under the receiver operating characteristic curve (AUROC) was 0.62 (95% CI: 0.54-0.71).
In lobar ICH survivors, we found associations between putative biomarkers of parenchymal CAA (FLP and strictly lobar CMBs) and putative biomarkers of leptomeningeal CAA (SAE and cSS). In a hospital population, CT biomarkers might help rule-in probable CAA (diagnosed using the Boston criteria), but their absence is probably not as useful to rule it out, suggesting an important continued role for MRI in ICH survivors with suspected CAA.
脑淀粉样血管病（CAA）是脑出血（ICH）的常见病因，采用波士顿标准进行诊断，包括磁共振成像（MRI）生物标志物（脑微出血（CMBs）和皮质表面铁沉积（cSS））。简化的爱丁堡标准包括计算机断层扫描（CT）生物标志物（蛛网膜下腔扩展（SAE）和指状突起（FLPs））。与CAA的MRI生物标志物相比，CT的潜在机制和诊断准确性尚不清楚。
我们纳入了140例自发性幕上叶脑出血幸存者，他们均接受了急性CT和MRI检查。我们评估了MRI和CT生物标志物之间的关联以及与基于MRI的标准相比CT的诊断准确性。
FLPs在严格的叶性CMB患者中更常见（44.7%对23.5%；p = 0.014），SAE在cSS患者中更常见（61.3%对31.2%；p = 0.002）。简化的爱丁堡标准中CAA类别的高概率显示，特异性为87.2%（95%置信区间（CI）：78.3 - 93.4），敏感性为29.6%（95%CI：18.0 - 43.6），阳性预测值为59.3%（95%CI：38.8 - 77.6），阴性预测值为66.4%（95%：CI 56.9 - 75.0），对于可能的CAA（与不太可能的CAA相比），阳性似然比为2.3（95%CI：1.2 - 4.6），阴性似然比为0.8（95%CI 0.7 - 1.0），由改良的波士顿标准定义；受试者工作特征曲线下面积（AUROC）为0.62（95%CI：0.54 - 0.71）。
在叶性脑出血幸存者中，我们发现实质CAA的假定生物标志物（FLP和严格的叶性CMBs）与软脑膜CAA的假定生物标志物（SAE和cSS）之间存在关联。在医院人群中，CT生物标志物可能有助于确诊可能的CAA（使用波士顿标准诊断），但它们的缺失可能对排除CAA不太有用，这表明MRI在疑似CAA的脑出血幸存者中仍具有重要的持续作用。
