Switzer Aaron, Charidimou Antreas, McCarter Stuart J, Vemuri Prashanthi, Nguyen Aivi, Przybelski Scott A, Lesnick Timothy G, Rabinstein Alejandro A, Brown Robert D, Knopman David S, Petersen Ronald C, Jack Clifford R, Reichard R Ross, Graff-Radford Jonathan
medRxiv. 2023 Nov 10:2023.11.09.23298325. doi: 10.1101/2023.11.09.23298325.
Updated criteria for the clinical-MRI diagnosis of cerebral amyloid angiopathy (CAA) have recently been proposed. However, their performance in individuals without intracerebral hemorrhage (ICH) or transient focal neurological episodes (TFNE) is unknown. We assessed the diagnostic performance of the Boston criteria version 2.0 for CAA diagnosis in a cohort of individuals presenting without symptomatic ICH.
Fifty-four participants from the Mayo Clinic Study of Aging or Alzheimer's Disease Research Center were included if they had an antemortem MRI with gradient-recall echo sequences and a brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared to v1.5 using histopathologically verified CAA as the reference standard.
Median age at MRI was 75 years (IQR 65-80) with 28/54 participants having histopathologically verified CAA (i.e., moderate-to-severe CAA in at least 1 lobar region). The sensitivity and specificity of the Boston criteria v2.0 were 28.6% (95%CI: 13.2-48.7%) and 65.3% (95%CI: 44.3-82.8%) for probable CAA diagnosis (AUC 0.47) and 75.0% (55.1-89.3) and 38.5% (20.2-59.4) for any CAA diagnosis (possible + probable; AUC: 0.57), respectively. The v2.0 Boston criteria was not superior in performance compared to the prior v1.5 criteria for either CAA diagnostic category.
The Boston criteria v2.0 have low accuracy in patients who are asymptomatic or only have cognitive symptoms.. Additional biomarkers need to be explored to optimize CAA diagnosis in this population.
最近有人提出了脑淀粉样血管病（CAA）临床磁共振成像（MRI）诊断的更新标准。然而，其在无脑出血（ICH）或短暂局灶性神经发作（TFNE）个体中的表现尚不清楚。我们评估了波士顿标准2.0版在一组无症状ICH个体中诊断CAA的诊断性能。
如果来自梅奥诊所衰老研究或阿尔茨海默病研究中心的54名参与者进行了梯度回波序列的生前MRI检查和有CAA评估的脑尸检，则将其纳入研究。以组织病理学证实的CAA作为参考标准，将波士顿标准v2.0的性能与v1.5进行比较。
MRI检查时的中位年龄为75岁（四分位间距65 - 80岁），54名参与者中有28名经组织病理学证实患有CAA（即至少1个脑叶区域存在中度至重度CAA）。对于可能的CAA诊断，波士顿标准v2.0的敏感性和特异性分别为28.6%（95%置信区间：13.2 - 48.7%）和65.3%（95%置信区间：44.3 - 82.8%）（曲线下面积0.47）；对于任何CAA诊断（可能+很可能），敏感性和特异性分别为75.0%（55.1 - 89.3）和38.5%（20.2 - 59.4）（曲线下面积：0.57）。对于任何一种CAA诊断类别，波士顿标准v2.0在性能上并不优于先前的v1.5标准。
波士顿标准v2.0在无症状或仅有认知症状的患者中准确性较低。需要探索额外的生物标志物以优化该人群的CAA诊断。
