简化的爱丁堡和改良的波士顿标准与脑叶内脑出血的淀粉样 PET 的关系。
Simplified Edinburgh and modified Boston criteria in relation to amyloid PET for lobar intracerebral hemorrhage.
机构信息
Laboratory for Neurobiology, Department of Neurosciences, KU Leuven, Belgium; VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Belgium; Department of Neurology, University Hospitals Leuven, Belgium.
Department of Neurology, Imeldaziekenhuis, Bonheiden, Belgium.
出版信息
Neuroimage Clin. 2022;35:103107. doi: 10.1016/j.nicl.2022.103107. Epub 2022 Jul 14.
BACKGROUND
Histopathological evidence of cerebral vascular amyloid β accumulation is the gold standard to diagnose cerebral amyloid angiopathy (CAA). Neuroimaging findings obtained with CT and MRI can suggest the presence of CAA when histopathology is lacking. We explored the role of amyloid PET in patients with lobar intracerebral hemorrhage (ICH) as this may provide molecular evidence for CAA as well.
METHODS
In this retrospective, monocenter analysis, we included consecutive patients with non-traumatic lobar ICH who had undergone amyloid PET. We categorized patients according to amyloid PET status and compared demographics and neuroimaging findings. We calculated sensitivity and specificity of the simplified Edinburgh criteria and amyloid PET with probable modified Boston criteria as reference standard, as well as sensitivity and specificity of the simplified Edinburgh and modified Boston criteria with amyloid PET status as molecular marker for presence or absence of CAA.
RESULTS
We included 38 patients of whom 24 (63%) were amyloid PET positive. Amyloid PET positive patients were older at presentation (p = 0.004). We observed no difference in prevalence of subarachnoid hemorrhages, fingerlike projections or microbleeds between both groups, but cortical superficial siderosis (p = 0.003) was more frequent in the amyloid PET positive group. In 5 out of 38 patients (13%), the modified Boston criteria were not fulfilled due to young age or concomitant vitamin K antagonist use with INR > 3.0. With the modified Boston criteria as reference standard, there was no difference in sensitivity nor specificity between the simplified Edinburgh criteria and amyloid PET status. With amyloid PET status as reference standard, there was also no difference in sensitivity nor specificity between the simplified Edinburgh and modified Boston criteria.
CONCLUSIONS
Amyloid PET was positive in 63% of lobar ICH patients. Under certain circumstances, patients might not be diagnosed with probable CAA according to the modified Boston criteria and in these cases, amyloid PET may be useful. Accuracy to predict CAA based on amyloid PET status did not differ between the simplified Edinburgh and modified Boston criteria.
背景
脑血管淀粉样 β 沉积的组织病理学证据是诊断脑淀粉样血管病（CAA）的金标准。当缺乏组织病理学证据时，CT 和 MRI 神经影像学检查结果可以提示 CAA 的存在。我们探讨了淀粉样蛋白 PET 在脑叶脑出血（ICH）患者中的作用，因为这也可能为 CAA 提供分子证据。
方法
在这项回顾性、单中心分析中，我们纳入了连续接受非创伤性脑叶 ICH 且接受淀粉样蛋白 PET 的患者。我们根据淀粉样蛋白 PET 结果对患者进行分类，并比较了人口统计学和神经影像学检查结果。我们计算了简化爱丁堡标准和淀粉样蛋白 PET 的敏感性和特异性，以可能的改良波士顿标准作为参考标准，以及简化爱丁堡标准和改良波士顿标准的敏感性和特异性，以淀粉样蛋白 PET 状态作为存在或不存在 CAA 的分子标志物。
结果
我们纳入了 38 例患者，其中 24 例（63%）淀粉样蛋白 PET 阳性。淀粉样蛋白 PET 阳性患者的发病年龄更大（p=0.004）。我们没有观察到两组之间蛛网膜下腔出血、指状突起或微出血的患病率存在差异，但皮质浅表铁沉积（p=0.003）在淀粉样蛋白 PET 阳性组更常见。在 38 例患者中，有 5 例（13%）由于年龄较小或同时使用维生素 K 拮抗剂且 INR>3.0，不符合改良波士顿标准。以改良波士顿标准作为参考标准，简化爱丁堡标准和淀粉样蛋白 PET 之间的敏感性和特异性没有差异。以淀粉样蛋白 PET 状态作为参考标准，简化爱丁堡标准和改良波士顿标准之间的敏感性和特异性也没有差异。
结论
脑叶 ICH 患者中，63%的患者淀粉样蛋白 PET 阳性。在某些情况下，根据改良波士顿标准，患者可能不会被诊断为可能的 CAA，在这种情况下，淀粉样蛋白 PET 可能有用。基于淀粉样蛋白 PET 状态预测 CAA 的准确性在简化爱丁堡标准和改良波士顿标准之间没有差异。
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