Fandler-Höfler Simon, Kaushik Kanishk, Storti Benedetta, Pikija Slaven, Mallon Dermot, Ambler Gareth, Damavandi Payam Tabaee, Panteleienko Larysa, Canavero Isabella, van Walderveen Marianne A A, van Etten Ellis S, DiFrancesco Jacopo Cosimo, Enzinger Christian, Gattringer Thomas, Bersano Anna, Wermer Marieke J H, Banerjee Gargi, Werring David J
Department of Neurology, Medical University of Graz, Graz, Austria.
Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
J Neurol Neurosurg Psychiatry. 2025 Feb 12. doi: 10.1136/jnnp-2024-335164.
We aimed to describe neuroimaging features, clinical profiles and long-term outcomes in patients with iatrogenic cerebral amyloid angiopathy (iCAA).
We performed a systematic literature search for case series of iCAA and included individual patients and their longitudinal clinical and neuroimaging data in this pooled cohort study. Patients meeting a modified version of the Queen Square criteria for iCAA were included. Baseline and follow-up MRIs were centrally analysed for markers of CAA using validated rating scales.
We included 51 patients (68.6% male, median age at presentation 48 years), 51.0% with probable and 49.0% with possible iCAA. We evaluated 219 MRIs acquired over a median follow-up time of 3.7 years (IQR 1.8-6.4). There were 43 symptomatic intracerebral haemorrhages (ICH) in 24 patients during follow-up, a rate of 16.7 per 100 patient-years.Patients with previous supratentorial brain surgery had an ipsilateral-dominant distribution and spread of haemorrhagic markers on MRI. 14/51 (27.5%) patients had transient inflammatory changes (cortical or parenchymal oedema, sulcal hyperintensities). Haemorrhagic markers progressed during follow-up. In addition to 43 symptomatic ICH, 36 asymptomatic ICH (mostly smaller intragyral haemorrhages) were detected on follow-up scans. Besides numerous lobar microbleeds (median 16 at baseline, 53 at last follow-up), deep microbleeds were present in 19.6% of patients at baseline and 44.4% at follow-up. Severe perivascular spaces in centrum semiovale were common at baseline (64.7%) and follow-up (95.6%).
Patients with iCAA appear to have distinctive MRI characteristics, which might differentiate iCAA from other CAA subtypes and provide new insights into underlying disease mechanisms.
我们旨在描述医源性脑淀粉样血管病（iCAA）患者的神经影像学特征、临床概况和长期预后。
我们对iCAA的病例系列进行了系统的文献检索，并将个体患者及其纵向临床和神经影像学数据纳入了这项汇总队列研究。纳入符合改良版女王广场iCAA标准的患者。使用经过验证的评分量表对基线和随访MRI进行集中分析，以寻找CAA的标志物。
我们纳入了51例患者（男性占68.6%，就诊时的中位年龄为48岁），其中51.0%为可能的iCAA，49.0%为疑似的iCAA。我们评估了在中位随访时间3.7年（四分位间距1.8 - 6.4年）内获取的219次MRI。随访期间，24例患者发生了43次有症状的颅内出血（ICH），发生率为每100患者年16.7次。既往幕上脑手术患者的出血标志物在MRI上呈同侧优势分布和扩散。14/51（27.5%）例患者出现短暂性炎症改变（皮质或实质水肿、脑沟强化）。随访期间出血标志物有所进展。除了43次有症状的ICH外，随访扫描还发现了36次无症状ICH（大多为较小的脑回内出血）。除了大量的脑叶微出血（基线时中位数为16个，末次随访时为53个）外，19.6%的患者在基线时存在深部微出血，随访时为44.4%。半卵圆中心的重度血管周围间隙在基线时（64.7%）和随访时（95.6%）都很常见。
iCAA患者似乎具有独特的MRI特征，这可能有助于将iCAA与其他CAA亚型区分开来，并为潜在的疾病机制提供新的见解。
