Department of Neurology, Boston University Medical Center and Boston University School of Medicine, MA (A.C.).
Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, INSERM 1253 iBrain, Tours, France (G.B.).
Stroke. 2022 Dec;53(12):3679-3687. doi: 10.1161/STROKEAHA.122.039501. Epub 2022 Sep 6.
The Boston criteria are used widely for the noninvasive diagnosis of sporadic cerebral amyloid angiopathy (CAA) and hence clinical decision-making, as well as research in the field. Yet, their exact diagnostic accuracy and validity remain (paradoxically) poorly studied. We performed a meta-analysis to synthesize evidence on the value and accuracy of the Boston criteria in diagnosing probable CAA patients.
In a systematic literature search, we identified studies with extractable data relevant for sensitivity and specificity of probable CAA diagnosis per the magnetic resonance imaging Boston criteria and neuropathological CAA verification. We included studies that have classified patients according to any version of the Boston criteria, based on available brain magnetic resonance imaging blood-sensitive sequences (index test) and had neuropathologic evaluation for CAA presence from brain tissue samples (diagnostic reference standard). Using a hierarchical (multilevel) logistic regression model, we calculated pooled diagnostic test accuracy for probable CAA diagnosis.
Seven studies, including 193 patients, 121 with neuropathologically verified CAA versus 72 non-CAA based on neuropathology definition, were included in the meta-analysis. The studies were of low-to-moderate quality and varied in several methodological aspects. The overall pooled sensitivity for probable CAA diagnosis was 66.7% (95% CI, 45.9%-82.6%) and specificity was 88.2% (95% CI, 68.5%-96.3%). A predefined subgroup analysis of 4 studies on Boston criteria v.1.0 (n=151) demonstrated a pooled sensitivity and specificity of 60% (95% CI, 45.1%-72.9%) and 93.1% (95% CI, 81.8%-97.6%), respectively. Five studies had data on Boston criteria v.1.5 (n=123): the pooled sensitivity and specificity for probable CAA diagnosis was 73.1% (95% CI, 45%-90.1%) and 86% (95% CI, 41.4%-98.1%), respectively.
The Boston criteria v.1.0 and v.1.5 appear to have moderate-to-good diagnostic accuracy for probable CAA in symptomatic patients, with high specificity but low-to-moderate sensitivity. Data are based on limited retrospective studies of overall low quality and at high risk of bias.
波士顿标准广泛用于非侵入性诊断散发性脑淀粉样血管病（CAA）和临床决策，以及该领域的研究。然而，其确切的诊断准确性和有效性仍然（矛盾地）研究不足。我们进行了一项荟萃分析，以综合关于波士顿标准在诊断可能的 CAA 患者方面的价值和准确性的证据。
在系统文献检索中，我们确定了具有可提取数据的研究，这些数据与根据磁共振成像波士顿标准和脑病理 CAA 验证对可能的 CAA 诊断的敏感性和特异性有关。我们纳入了根据任何版本的波士顿标准对患者进行分类的研究，这些标准基于可用的脑磁共振成像血液敏感序列（指标测试），并从脑组织样本中进行了 CAA 存在的病理评估（诊断参考标准）。使用分层（多水平）逻辑回归模型，我们计算了可能的 CAA 诊断的汇总诊断测试准确性。
纳入了 7 项研究，包括 193 名患者，121 名患者经脑病理学验证为 CAA，72 名患者为非 CAA，依据脑病理学定义。研究质量为低至中等，在几个方法学方面存在差异。可能的 CAA 诊断的总体汇总敏感性为 66.7%（95%CI，45.9%-82.6%），特异性为 88.2%（95%CI，68.5%-96.3%）。对 4 项关于波士顿标准 v.1.0（n=151）的研究进行的预先定义的亚组分析表明，汇总敏感性和特异性分别为 60%（95%CI，45.1%-72.9%）和 93.1%（95%CI，81.8%-97.6%）。5 项研究有关于波士顿标准 v.1.5（n=123）的数据：可能的 CAA 诊断的汇总敏感性和特异性分别为 73.1%（95%CI，45%-90.1%）和 86%（95%CI，41.4%-98.1%）。
在有症状的患者中，波士顿标准 v.1.0 和 v.1.5 似乎具有中等至良好的可能 CAA 诊断准确性，特异性高，但敏感性低至中等。数据基于总体质量较低且存在高度偏倚风险的有限回顾性研究。
