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Romoli M, Marinoni G, Tagliabue L, Capozza A, Matteucci F, Mattone V, Longoni M, Cenni P, Ruggiero M, Rifino N, Canavero I, Boncoraglio G, Stanziano M, Bersano A, Storti B. 18FFlutemetamol-PET Aided Classification of Cerebral Amyloid Angiopathy: A Multicenter Study. Neurology 2024; 103:e209719. [PMID: 39083717 DOI: 10.1212/wnl.0000000000209719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES Cerebral amyloid angiopathy (CAA)-related features on neuroimaging often coexist with signs of arteriolosclerosis-small vessel disease on neuroimaging in people with intracranial hemorrhage (ICH). This study aimed at defining the value of amyloid pathology detected by 18Fflutemetamol PET in reclassification and stratification of risk of bleeding in people with mixed CAA-arteriolosclerosis features. METHODS We included consecutive patients admitted to 2 institutions (2018-2023) with spontaneous symptomatic ICH, subarachnoid hemorrhage (SAH), transient focal neurologic episodes (TFNE), or cognitive impairment and MRI showing CAA hallmarks. All patients underwent brain magnetic resonance imaging (MRI) with susceptibility weighted imaging and 18Fflutemetamol PET imaging and were followed up for at least 1 year. We compared cases with CAA and arteriolosclerosis + CAA features and defined long-term outcomes (composite outcome including death, ICH, ischemic stroke, SAH, TFNE) depending on PET status (CAA/amyloid pathology vs arteriolosclerosis-predominant groups). RESULTS Among 47 patients, according to PET and MRI imaging, 38 patients were reclassified in the CAA/amyloid pathology group and 9 in the arteriolosclerosis-predominant group, with similar cardiovascular risk factors but a significantly higher lobar microbleed burden for the former group. The CAA/amyloid pathology group had higher rates of composite outcome (43.9 vs 11.1 events per 100 patient-year; p = 0.039) and ICH (36.5 vs 5.6 events per 100 patient-years; p = 0.04) compared with the arteriolosclerosis-predominant group. DISCUSSION 18FFlutemetamol PET imaging can help in reclassification of mixed arteriolosclerosis + CAA into CAA/amyloid pathology and arteriolosclerosis-predominant, with implications on long-term risk of recurrent events. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that 18Fflutemetamol PET can distinguish between CAA + arteriolosclerosis and arteriolosclerosis-predominant pathology.
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Affiliation(s)
- Michele Romoli
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Giulia Marinoni
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Luca Tagliabue
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Antonella Capozza
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Federica Matteucci
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Vincenzo Mattone
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Marco Longoni
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Patrizia Cenni
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Maria Ruggiero
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Nicola Rifino
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Isabella Canavero
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Giorgio Boncoraglio
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Mario Stanziano
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Anna Bersano
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
| | - Benedetta Storti
- From the Neurology and Stroke Unit (M. Romoli, M.L.), Nuclear Medicine (F.M., V.M.), Diagnostic Neuroradiology Unit (P.C.), and Interventional Neuroradiology Unit (M. Ruggiero), Bufalini Hospital, AUSL Romagna, Cesena; Cerebrovascular Unit (G.M., N.R., I.C., G.B., A.B., B.S.) and Neuroradiology Unit (M.S.), Fondazione IRCCS Istituto Neurologico Carlo Besta; and Nuclear Medicine Department (L.T., A.C.), Ospedale San Paolo, Milan, Italy
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Lombardi G, Berti V, Ginestroni A, Nacmias B, Sorbi S. The Association Between Positive Amyloid-PET and Cognitive Decline Is Not Always Supportive of Alzheimer's Disease: Suggestions from a Case Report. J Alzheimers Dis Rep 2024; 8:281-288. [PMID: 38405347 PMCID: PMC10894606 DOI: 10.3233/adr-230183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Amyloid-β deposition is the pathological hallmark of both cerebral amyloid angiopathy and Alzheimer's disease dementia, clinical conditions that can share cognitive decline and positive Amyloid-PET scan. A case is reported involving an 82-year-old Italian female who presented initially a memory deficit, later transient focal neurologic episodes, and finally two symptomatic lobar intracerebral hemorrhages. In light of these events, MRI and PET imaging findings, acquired before cerebral hemorrhages, are reconsidered and discussed, highlighting the utility of Amyloid-PET in supporting an in vivo diagnosis of cerebral amyloid angiopathy.
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Affiliation(s)
- Gemma Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Valentina Berti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Nuclear Medicine Unit, University of Florence, Florence, Italy
| | | | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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Kuo PY, Tsai HH, Lee BC, Chiang PT, Liu CJ, Chen YF, Jeng JS, Yen RF, Tsai LK. Differences in lobar microbleed topography in cerebral amyloid angiopathy and hypertensive arteriopathy. Sci Rep 2024; 14:3774. [PMID: 38355951 PMCID: PMC10866968 DOI: 10.1038/s41598-024-54243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/10/2024] [Indexed: 02/16/2024] Open
Abstract
Lobar cerebral microbleeds are a characteristic neuroimaging finding in cerebral amyloid angiopathy (CAA) but can also be found in hypertensive arteriolosclerosis. We aimed to investigate whether CAA is more associated with intracortical lobar microbleeds than hypertensive arteriosclerosis. Ninety-one survivors of spontaneous intracerebral hemorrhage with at least one lobar microbleed were included and underwent brain MRI and amyloid PET. We categorized lobar microbleeds as intracortical, juxtacortical, or subcortical. We assessed the associations between the lobar microbleed categories and microangiopathy subtypes or cerebral amyloid load based on the Pittsburgh Compound-B PET standardized uptake value ratio (SUVR). Patients with CAA had a higher prevalence of intracortical lobar microbleeds (80.0% vs. 50.8%, P = 0.011) and lower prevalence of subcortical lobar microbleeds (13.3% vs. 60.1%, P < 0.001) than patients with hypertensive arteriolosclerosis. Strictly intracortical/juxtacortical lobar microbleeds were associated with CAA (OR 18.9 [1.9-191.4], P = 0.013), while the presence of subcortical lobar microbleeds was associated with hypertensive arteriolosclerosis (OR 10.9 [1.8-68.1], P = 0.010). Amyloid retention was higher in patients with strictly intracortical/juxtacortical CMBs than those without (SUVR = 1.15 [1.05-1.52] vs. 1.08 [1.02-1.19], P = 0.039). Amyloid retention positively correlated with the number of intracortical lobar microbleeds (P < 0.001) and negatively correlated with the number of subcortical lobar microbleeds (P = 0.018). CAA and cortical amyloid deposition are more strongly associated with strictly intracortical/juxtacortical microbleeds than subcortical lobar microbleeds. Categorization of lobar microbleeds based on anatomical location may help differentiate the underlying microangiopathy and potentially improve the accuracy of current neuroimaging criteria for cerebral small vessel disease.
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Affiliation(s)
- Pin-Yan Kuo
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Pu-Tien Chiang
- Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Chia-Ju Liu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
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Kobayashi Y, Hiraoka K, Itabashi R, Saito T, Kawabata Y, Yazawa Y, Funaki Y, Furumoto S, Okamura N, Furukawa K, Ishiki A, Arai H, Yanai K, Tashiro M, Sekijima Y. Amyloid accumulation in cases of suspected comorbid cerebral amyloid angiopathy and isolated cortical venous thrombosis. J Neurol Sci 2024; 457:122892. [PMID: 38266518 DOI: 10.1016/j.jns.2024.122892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/26/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND AIM The differentiation of isolated cortical venous thrombosis (ICVT) from cerebral amyloid angiopathy (CAA) can be difficult because both diseases share similar neurological symptoms and imaging findings. N-methyl-11C-2-(4'-methylaminophenyl)-6-hydroxybenzo-thiazole (11C-PiB) positron emission tomography (PET) functions as a diagnostic modality for CAA by detecting amyloid deposition. The present prospective study evaluated amyloid deposition using 11C-PiB-PET in consecutive patients with suspected ICVT. METHOD This study was a prospective observational study. Patients who attended or were hospitalized between May 2019 and March 2020 were included in the analysis. Consecutive patients who met the criteria for suspicion of ICVT were enrolled in the study, and the clinical course, symptoms, imaging findings (including magnetic resonance imaging), and the 11C-PiB-PET findings of each case were analyzed. RESULTS The study cohort included four patients (64-82 years of age, all women). In one younger patient, 11C-PiB-PET afforded no findings suggestive of CAA, whereas the remaining three patients exhibited 11C-PiB-PET findings suggestive of CAA. CONCLUSION Although 11C-PiB-PET would be a reasonable modality for distinguishing ICVT from CAA, especially in younger patients, it might be difficult to differentiate ICVT from CAA in elderly patients because of the potential deposition of amyloid. CLINICAL TRIAL REGISTRATION URL: https://www.umin.ac.jp/ctr/ Unique identifier: UMIN 000037101.
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Affiliation(s)
- Yuya Kobayashi
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan; Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Kotaro Hiraoka
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, 6-3 Aramaki, Aoba-ku, Sendai 980-8578, Japan.
| | - Ryo Itabashi
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan; Stroke Center, Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Iwate 028-3695, Japan.
| | - Takuya Saito
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan
| | - Yuichi Kawabata
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan
| | - Yukako Yazawa
- Department of Stroke Neurology, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, Miyagi 982-8523, Japan.
| | - Yoshihito Funaki
- Division of Radiopharmaceutical Chemistry, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan.
| | - Shozo Furumoto
- Division of Radiopharmaceutical Chemistry, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan.
| | - Nobuyuki Okamura
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, 6-3 Aramaki, Aoba-ku, Sendai 980-8578, Japan; Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Katsutoshi Furukawa
- Division of the Community of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
| | - Aiko Ishiki
- Division of the Community of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
| | - Hiroyuki Arai
- Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
| | - Kazuhiko Yanai
- Department of Pharmacology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Manabu Tashiro
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, 6-3 Aramaki, Aoba-ku, Sendai 980-8578, Japan.
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
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Raposo N, Périole C, Planton M. In-vivo diagnosis of cerebral amyloid angiopathy: an updated review. Curr Opin Neurol 2024; 37:19-25. [PMID: 38038409 DOI: 10.1097/wco.0000000000001236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW Sporadic cerebral amyloid angiopathy (CAA) is a highly prevalent small vessel disease in ageing population with potential severe complications including lobar intracerebral hemorrhage (ICH), cognitive impairment, and dementia. Although diagnosis of CAA was made only with postmortem neuropathological examination a few decades ago, diagnosing CAA without pathological proof is now allowed in living patients. This review focuses on recently identified biomarkers of CAA and current diagnostic criteria. RECENT FINDINGS Over the past few years, clinicians and researchers have shown increased interest for CAA, and important advances have been made. Thanks to recent insights into mechanisms involved in CAA and advances in structural and functional neuroimaging, PET amyloid tracers, cerebrospinal fluid and plasma biomarkers analysis, a growing number of biomarkers of CAA have been identified. Imaging-based diagnostic criteria including emerging biomarkers have been recently developed or updated, enabling accurate and earlier diagnosis of CAA in living patients. SUMMARY Recent advances in neuroimaging allow diagnosing CAA in the absence of pathological examination. Current imaging-based criteria have high diagnostic performance in patients presenting with ICH, but is more limited in other clinical context such as cognitively impaired patients or asymptomatic individuals. Further research is still needed to improve diagnostic accuracy.
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Affiliation(s)
- Nicolas Raposo
- Department of neurology, Toulouse University Hospital
- Clinical Investigation Center, CIC1436, Toulouse University Hospital, F-CRIN/Strokelink Network, Toulouse
- Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Charlotte Périole
- Department of neurology, Toulouse University Hospital
- Clinical Investigation Center, CIC1436, Toulouse University Hospital, F-CRIN/Strokelink Network, Toulouse
| | - Mélanie Planton
- Department of neurology, Toulouse University Hospital
- Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
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Banerjee G, Collinge J, Fox NC, Lashley T, Mead S, Schott JM, Werring DJ, Ryan NS. Clinical considerations in early-onset cerebral amyloid angiopathy. Brain 2023; 146:3991-4014. [PMID: 37280119 PMCID: PMC10545523 DOI: 10.1093/brain/awad193] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
Cerebral amyloid angiopathy (CAA) is an important cerebral small vessel disease associated with brain haemorrhage and cognitive change. The commonest form, sporadic amyloid-β CAA, usually affects people in mid- to later life. However, early-onset forms, though uncommon, are increasingly recognized and may result from genetic or iatrogenic causes that warrant specific and focused investigation and management. In this review, we firstly describe the causes of early-onset CAA, including monogenic causes of amyloid-β CAA (APP missense mutations and copy number variants; mutations of PSEN1 and PSEN2) and non-amyloid-β CAA (associated with ITM2B, CST3, GSN, PRNP and TTR mutations), and other unusual sporadic and acquired causes including the newly-recognized iatrogenic subtype. We then provide a structured approach for investigating early-onset CAA, and highlight important management considerations. Improving awareness of these unusual forms of CAA amongst healthcare professionals is essential for facilitating their prompt diagnosis, and an understanding of their underlying pathophysiology may have implications for more common, late-onset, forms of the disease.
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Affiliation(s)
- Gargi Banerjee
- MRC Prion Unit at University College London (UCL), Institute of Prion Diseases, UCL, London, W1W 7FF, UK
| | - John Collinge
- MRC Prion Unit at University College London (UCL), Institute of Prion Diseases, UCL, London, W1W 7FF, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
| | - Tammaryn Lashley
- The Queen Square Brain Bank for Neurological Disorders, Department of Clinical and Movement Disorders, UCL Queen Square Institute of Neurology, London, W1 1PJ, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Simon Mead
- MRC Prion Unit at University College London (UCL), Institute of Prion Diseases, UCL, London, W1W 7FF, UK
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Natalie S Ryan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1E 6BT, UK
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7
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Cogswell PM, Fan AP. Multimodal comparisons of QSM and PET in neurodegeneration and aging. Neuroimage 2023; 273:120068. [PMID: 37003447 PMCID: PMC10947478 DOI: 10.1016/j.neuroimage.2023.120068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Quantitative susceptibility mapping (QSM) has been used to study susceptibility changes that may occur based on tissue composition and mineral deposition. Iron is a primary contributor to changes in magnetic susceptibility and of particular interest in applications of QSM to neurodegeneration and aging. Iron can contribute to neurodegeneration through inflammatory processes and via interaction with aggregation of disease-related proteins. To better understand the local susceptibility changes observed on QSM, its signal has been studied in association with other imaging metrics such as positron emission tomography (PET). The associations of QSM and PET may provide insight into the pathophysiology of disease processes, such as the role of iron in aging and neurodegeneration, and help to determine the diagnostic utility of QSM as an indirect indicator of disease processes typically evaluated with PET. In this review we discuss the proposed mechanisms and summarize prior studies of the associations of QSM and amyloid PET, tau PET, TSPO PET, FDG-PET, 15O-PET, and F-DOPA PET in evaluation of neurologic diseases with a focus on aging and neurodegeneration.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Audrey P Fan
- Department of Biomedical Engineering and Department of Neurology, University of California, Davis, 1590 Drew Avenue, Davis, CA 95618, USA
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8
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Abstract
Cerebral amyloid angiopathy (CAA) is associated with deposition of amyloid proteins within the intracranial vessels. It is most frequently sporadic and risk increases with advancing age. Amyloid deposition is associated with increased risk of peripheral microhemorrhage, lobar hemorrhage, and/or repetitive subarachnoid hemorrhage. The presence of a peripherally located lobar hemorrhage on computed tomography in an elderly patient should raise concern for underlying CAA, as should multiple foci of peripheral susceptibility artifact or superficial siderosis on susceptibility-weighted imaging, the most sensitive modality for these findings. Newer PET radiotracers are also useful in detecting amyloid deposition.
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Affiliation(s)
- Laszlo Szidonya
- Diagnostic Radiology, Oregon Health & Science University, L340, 3245 Southwest Pavilion Loop, Portland, OR 97239, USA; Diagnostic Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Joshua P Nickerson
- Diagnostic Radiology, School of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
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9
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Na HK, Kim HK, Lee HS, Park M, Lee JH, Ryu YH, Cho H, Lyoo CH. Role of Enlarged Perivascular Space in the Temporal Lobe in Cerebral Amyloidosis. Ann Neurol 2023; 93:965-978. [PMID: 36651566 DOI: 10.1002/ana.26601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/01/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although growing evidence suggests that perivascular space (PVS) serves as a clearance route for amyloid and tau, the association between enlarged PVS (EPVS) and Alzheimer disease is highly inconsistent across studies. As the conventional visual rating systems for EPVS were insufficient to predict amyloid/tau/neurodegeneration (A/T/N) status, we developed a new rating scale for EPVS located in the temporal lobe (T-EPVS). METHODS EPVS located in the basal ganglia (BG-EPVS), centrum semiovale (CS-EPVS), and T-EPVS was visually rated in 272 individuals (healthy controls, n = 96; mild cognitive impairment, n = 106; dementia, n = 70) who underwent structural magnetic resonance imaging (MRI) and dual positron emission tomography scans (18 F-flortaucipir and 18 F-florbetaben). T-EPVS and BG-EPVS were defined as high degree when the counts in any hemisphere were >10, and the CS-EPVS cutoff was >20. Logistic regression models were constructed to investigate whether the regional EPVS burden was predictive of A/T/N status. The derived models were externally validated in a temporal validation cohort (n = 195) that underwent MRI studies using a different scanner. RESULTS Compared with those with low-degree T-EPVS (23/136, 16.9%), individuals with high-degree T-EPVS/CS-EPVS but low-degree BG-EPVS were more likely to exhibit amyloid positivity (46/56, 82.1%). High-degree T-EPVS burden (odds ratio [OR] = 7.251, 95% confidence interval [CI] = 3.296-15.952) and low-degree BG-EPVS (OR = 0.241, 95% CI = 0.109-0.530) were predictive of amyloid positivity. Although high-degree T-EPVS was associated with tau positivity, the association was no longer significant after adjusting for amyloid and neurodegeneration status. INTERPRETATION Investigating the burden and topographic distribution of EPVS including T-EPVS may be useful for predicting amyloid status, indicating that impaired perivascular drainage may contribute to cerebral amyloidosis. ANN NEUROL 2023.
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Affiliation(s)
- Han Kyu Na
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Han-Kyeol Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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10
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Charidimou A, Boulouis G, Frosch MP, Baron JC, Pasi M, Albucher JF, Banerjee G, Barbato C, Bonneville F, Brandner S, Calviere L, Caparros F, Casolla B, Cordonnier C, Delisle MB, Deramecourt V, Dichgans M, Gokcal E, Herms J, Hernandez-Guillamon M, Jäger HR, Jaunmuktane Z, Linn J, Martinez-Ramirez S, Martínez-Sáez E, Mawrin C, Montaner J, Moulin S, Olivot JM, Piazza F, Puy L, Raposo N, Rodrigues MA, Roeber S, Romero JR, Samarasekera N, Schneider JA, Schreiber S, Schreiber F, Schwall C, Smith C, Szalardy L, Varlet P, Viguier A, Wardlaw JM, Warren A, Wollenweber FA, Zedde M, van Buchem MA, Gurol ME, Viswanathan A, Al-Shahi Salman R, Smith EE, Werring DJ, Greenberg SM. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol 2022; 21:714-725. [PMID: 35841910 PMCID: PMC9389452 DOI: 10.1016/s1474-4422(22)00208-3] [Citation(s) in RCA: 203] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is an age-related small vessel disease, characterised pathologically by progressive deposition of amyloid β in the cerebrovascular wall. The Boston criteria are used worldwide for the in-vivo diagnosis of CAA but have not been updated since 2010, before the emergence of additional MRI markers. We report an international collaborative study aiming to update and externally validate the Boston diagnostic criteria across the full spectrum of clinical CAA presentations. METHODS In this multicentre, hospital-based, retrospective, MRI and neuropathology diagnostic accuracy study, we did a retrospective analysis of clinical, radiological, and histopathological data available to sites participating in the International CAA Association to formulate updated Boston criteria and establish their diagnostic accuracy across different populations and clinical presentations. Ten North American and European academic medical centres identified patients aged 50 years and older with potential CAA-related clinical presentations (ie, spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathological assessment for CAA diagnosis. MRI scans were centrally rated at Massachusetts General Hospital (Boston, MA, USA) for haemorrhagic and non-haemorrhagic CAA markers, and brain tissue samples were rated by neuropathologists at the contributing sites. We derived the Boston criteria version 2.0 (v2.0) by selecting MRI features to optimise diagnostic specificity and sensitivity in a prespecified derivation cohort (Boston cases 1994-2012, n=159), then externally validated the criteria in a prespecified temporal validation cohort (Boston cases 2012-18, n=59) and a geographical validation cohort (non-Boston cases 2004-18; n=123), comparing accuracy of the new criteria to the currently used modified Boston criteria with histopathological assessment of CAA as the diagnostic standard. We also assessed performance of the v2.0 criteria in patients across all cohorts who had the diagnostic gold standard of brain autopsy. FINDINGS The study protocol was finalised on Jan 15, 2017, patient identification was completed on Dec 31, 2018, and imaging analyses were completed on Sept 30, 2019. Of 401 potentially eligible patients presenting to Massachusetts General Hospital, 218 were eligible to be included in the analysis; of 160 patient datasets from other centres, 123 were included. Using the derivation cohort, we derived provisional criteria for probable CAA requiring the presence of at least two strictly lobar haemorrhagic lesions (ie, intracerebral haemorrhages, cerebral microbleeds, or foci of cortical superficial siderosis) or at least one strictly lobar haemorrhagic lesion and at least one white matter characteristic (ie, severe visible perivascular spaces in centrum semiovale or white matter hyperintensities in a multispot pattern). The sensitivity and specificity of these criteria were 74·8% (95% CI 65·4-82·7) and 84·6% (71·9-93·1) in the derivation cohort, 92·5% (79·6-98·4) and 89·5% (66·9-98·7) in the temporal validation cohort, 80·2% (70·8-87·6) and 81·5% (61·9-93·7) in the geographical validation cohort, and 74·5% (65·4-82·4) and 95·0% (83·1-99·4) in all patients who had autopsy as the diagnostic standard. The area under the receiver operating characteristic curve (AUC) was 0·797 (0·732-0·861) in the derivation cohort, 0·910 (0·828-0·992) in the temporal validation cohort, 0·808 (0·724-0·893) in the geographical validation cohort, and 0·848 (0·794-0·901) in patients who had autopsy as the diagnostic standard. The v2.0 Boston criteria for probable CAA had superior accuracy to the current Boston criteria (sensitivity 64·5% [54·9-73·4]; specificity 95·0% [83·1-99·4]; AUC 0·798 [0·741-0854]; p=0·0005 for comparison of AUC) across all individuals who had autopsy as the diagnostic standard. INTERPRETATION The Boston criteria v2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their specificity in our cohorts of patients aged 50 years and older presenting with spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes. Future studies will be needed to determine generalisability of the v.2.0 criteria across the full range of patients and clinical presentations. FUNDING US National Institutes of Health (R01 AG26484).
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France
| | - Matthew P Frosch
- C S Kubik Laboratory of Neuropathology, Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean-Claude Baron
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Marco Pasi
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean Francois Albucher
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Carmen Barbato
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Fabrice Bonneville
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Sebastian Brandner
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Lionel Calviere
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - François Caparros
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Barbara Casolla
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Charlotte Cordonnier
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Marie-Bernadette Delisle
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Vincent Deramecourt
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy) and German Center for Neurodegenerative Diseases, Munich, Germany
| | - Elif Gokcal
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jochen Herms
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hans Rolf Jäger
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Zane Jaunmuktane
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Jennifer Linn
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Dresden, Germany
| | - Sergi Martinez-Ramirez
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Elena Martínez-Sáez
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christian Mawrin
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Institute of Biomedicine of Seville, Hospital Universitario Virgen Macarena, Consejo Superior de Investigaciones Científicas, University of Seville, Spain
| | - Solene Moulin
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean-Marc Olivot
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Fabrizio Piazza
- CAA and AD Translational Research and Biomarkers Laboratory, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laurent Puy
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Nicolas Raposo
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Jose Rafael Romero
- Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | | | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Stefanie Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Corentin Schwall
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Levente Szalardy
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Pascale Varlet
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Alain Viguier
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Warren
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Helios Dr Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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11
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Dewenter A, Jacob MA, Cai M, Gesierich B, Hager P, Kopczak A, Biel D, Ewers M, Tuladhar AM, de Leeuw FE, Dichgans M, Franzmeier N, Duering M. Disentangling the effects of Alzheimer's and small vessel disease on white matter fibre tracts. Brain 2022; 146:678-689. [PMID: 35859352 PMCID: PMC9924910 DOI: 10.1093/brain/awac265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/30/2022] [Accepted: 06/25/2022] [Indexed: 12/27/2022] Open
Abstract
Alzheimer's disease and cerebral small vessel disease are the two leading causes of cognitive decline and dementia and coexist in most memory clinic patients. White matter damage as assessed by diffusion MRI is a key feature in both Alzheimer's and cerebral small vessel disease. However, disease-specific biomarkers of white matter alterations are missing. Recent advances in diffusion MRI operating on the fixel level (fibre population within a voxel) promise to advance our understanding of disease-related white matter alterations. Fixel-based analysis allows derivation of measures of both white matter microstructure, measured by fibre density, and macrostructure, measured by fibre-bundle cross-section. Here, we evaluated the capacity of these state-of-the-art fixel metrics to disentangle the effects of cerebral small vessel disease and Alzheimer's disease on white matter integrity. We included three independent samples (total n = 387) covering genetically defined cerebral small vessel disease and age-matched controls, the full spectrum of biomarker-confirmed Alzheimer's disease including amyloid- and tau-PET negative controls and a validation sample with presumed mixed pathology. In this cross-sectional analysis, we performed group comparisons between patients and controls and assessed associations between fixel metrics within main white matter tracts and imaging hallmarks of cerebral small vessel disease (white matter hyperintensity volume, lacune and cerebral microbleed count) and Alzheimer's disease (amyloid- and tau-PET), age and a measure of neurodegeneration (brain volume). Our results showed that (i) fibre density was reduced in genetically defined cerebral small vessel disease and strongly associated with cerebral small vessel disease imaging hallmarks; (ii) fibre-bundle cross-section was mainly associated with brain volume; and (iii) both fibre density and fibre-bundle cross-section were reduced in the presence of amyloid, but not further exacerbated by abnormal tau deposition. Fixel metrics were only weakly associated with amyloid- and tau-PET. Taken together, our results in three independent samples suggest that fibre density captures the effect of cerebral small vessel disease, while fibre-bundle cross-section is largely determined by neurodegeneration. The ability of fixel-based imaging markers to capture distinct effects on white matter integrity can propel future applications in the context of precision medicine.
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Affiliation(s)
- Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | - Mina A Jacob
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mengfei Cai
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benno Gesierich
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Paul Hager
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Institute for AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Anna Kopczak
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | - Davina Biel
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- German Center for Neurodegenerative Disease (DZNE), Munich, Germany
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- German Center for Neurodegenerative Disease (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Marco Duering
- Correspondence to: Marco Duering Medical Image Analysis Center (MIAC AG) Marktgasse 8 CH-4051 Basel Switzerland E-mail:
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12
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Goeldlin M, Stewart C, Radojewski P, Wiest R, Seiffge D, Werring DJ. Clinical neuroimaging in intracerebral haemorrhage related to cerebral small vessel disease: contemporary practice and emerging concepts. Expert Rev Neurother 2022; 22:579-594. [PMID: 35850578 DOI: 10.1080/14737175.2022.2104157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION About 80% of all non-traumatic intracerebral haemorrhage (ICH) are caused by the sporadic cerebral small vessel diseases deep perforator arteriopathy (DPA, also termed hypertensive arteriopathy or arteriolosclerosis) and cerebral amyloid angiopathy (CAA), though these frequently co-exist in older people. Contemporary neuroimaging (MRI and CT) detects an increasing spectrum of haemorrhagic and non-haemorrhagic imaging biomarkers of small vessel disease which may identify the underlying arteriopathies. AREAS COVERED We discuss biomarkers for cerebral small vessel disease subtypes in ICH, and explore their implications for clinical practice and research. EXPERT OPINION ICH is not a single disease, but results from a defined range of vascular pathologies with important implications for prognosis and treatment. The terms "primary" and "hypertensive" ICH are poorly defined and should be avoided, as they encourage incomplete investigation and classification. Imaging-based criteria for CAA will show improved diagnostic accuracy, but specific imaging biomarkers of DPA are needed. Ultra-high-field 7T-MRI using structural and quantitative MRI may provide further insights into mechanisms and pathophysiology of small vessel disease. We expect neuroimaging biomarkers and classifications to allow personalized treatments (e.g. antithrombotic drugs) in clinical practice and to improve patient selection and monitoring in trials of targeted therapies directed at the underlying arteriopathies.
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Affiliation(s)
- Martina Goeldlin
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Catriona Stewart
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Piotr Radojewski
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - David J Werring
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, United Kingdom
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13
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Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2022; 53:e282-e361. [PMID: 35579034 DOI: 10.1161/str.0000000000000407] [Citation(s) in RCA: 379] [Impact Index Per Article: 189.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - William J Mack
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison
| | | | | | - Ilana M Ruff
- AHA Stroke Council Stroke Performance Measures Oversight Committee liaison
| | | | | | | | - Kevin N Sheth
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison.,AAN representative
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14
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Fisher RA, Miners JS, Love S. Pathological changes within the cerebral vasculature in Alzheimer's disease: New perspectives. Brain Pathol 2022; 32:e13061. [PMID: 35289012 PMCID: PMC9616094 DOI: 10.1111/bpa.13061] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 12/14/2022] Open
Abstract
Cerebrovascular disease underpins vascular dementia (VaD), but structural and functional changes to the cerebral vasculature contribute to disease pathology and cognitive decline in Alzheimer's disease (AD). In this review, we discuss the contribution of cerebral amyloid angiopathy and non‐amyloid small vessel disease in AD, and the accompanying changes to the density, maintenance and remodelling of vessels (including alterations to the composition and function of the cerebrovascular basement membrane). We consider how abnormalities of the constituent cells of the neurovascular unit – particularly of endothelial cells and pericytes – and impairment of the blood‐brain barrier (BBB) impact on the pathogenesis of AD. We also discuss how changes to the cerebral vasculature are likely to impair Aβ clearance – both intra‐periarteriolar drainage (IPAD) and transport of Aβ peptides across the BBB, and how impaired neurovascular coupling and reduced blood flow in relation to metabolic demand increase amyloidogenic processing of APP and the production of Aβ. We review the vasoactive properties of Aβ peptides themselves, and the probable bi‐directional relationship between vascular dysfunction and Aβ accumulation in AD. Lastly, we discuss recent methodological advances in transcriptomics and imaging that have provided novel insights into vascular changes in AD, and recent advances in assessment of the retina that allow in vivo detection of vascular changes in the early stages of AD.
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Affiliation(s)
- Robert A Fisher
- Dementia Research Group, University of Bristol Medical School, Bristol, UK
| | - J Scott Miners
- Dementia Research Group, University of Bristol Medical School, Bristol, UK
| | - Seth Love
- Dementia Research Group, University of Bristol Medical School, Bristol, UK
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15
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Margraf NG, Jensen-Kondering U, Weiler C, Leypoldt F, Maetzler W, Philippen S, Bartsch T, Flüh C, Röcken C, Möller B, Royl G, Neumann A, Brüggemann N, Roeben B, Schulte C, Bender B, Berg D, Kuhlenbäumer G. Cerebrospinal Fluid Biomarkers in Cerebral Amyloid Angiopathy: New Data and Quantitative Meta-Analysis. Front Aging Neurosci 2022; 14:783996. [PMID: 35237145 PMCID: PMC8884145 DOI: 10.3389/fnagi.2022.783996] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/03/2022] [Indexed: 01/31/2023] Open
Abstract
Background To evaluate the diagnostic accuracy of cerebrospinal fluid (CSF) biomarkers in patients with probable cerebral amyloid angiopathy (CAA) according to the modified Boston criteria in a retrospective multicentric cohort. Methods Beta-amyloid 1-40 (Aβ40), beta-amyloid 1-42 (Aβ42), total tau (t-tau), and phosphorylated tau 181 (p-tau181) were measured in 31 patients with probable CAA, 28 patients with Alzheimer’s disease (AD), and 30 controls. Receiver-operating characteristics (ROC) analyses were performed for the measured parameters as well as the Aβ42/40 ratio to estimate diagnostic parameters. A meta-analysis of all amenable published studies was conducted. Results In our data Aβ42/40 (AUC 0.88) discriminated best between CAA and controls while Aβ40 did not perform well (AUC 0.63). Differentiating between CAA and AD, p-tau181 (AUC 0.75) discriminated best in this study while Aβ40 (AUC 0.58) and Aβ42 (AUC 0.54) provided no discrimination. In the meta-analysis, Aβ42/40 (AUC 0.90) showed the best discrimination between CAA and controls followed by t-tau (AUC 0.79), Aβ40 (AUC 0.76), and p-tau181 (AUC 0.71). P-tau181 (AUC 0.76), Aβ40 (AUC 0.73), and t-tau (AUC 0.71) differentiated comparably between AD and CAA while Aβ42 (AUC 0.54) did not. In agreement with studies examining AD biomarkers, Aβ42/40 discriminated excellently between AD and controls (AUC 0.92–0.96) in this study as well as the meta-analysis. Conclusion The analyzed parameters differentiate between controls and CAA with clinically useful accuracy (AUC > ∼0.85) but not between CAA and AD. Since there is a neuropathological, clinical and diagnostic continuum between CAA and AD, other diagnostic markers, e.g., novel CSF biomarkers or other parameters might be more successful.
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Affiliation(s)
- Nils G. Margraf
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- *Correspondence: Nils G. Margraf,
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Caroline Weiler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Sarah Philippen
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Bettina Möller
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Georg Royl
- Department of Neurology, University Medical Center Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Alexander Neumann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University Medical Center Schleswig Holstein, Campus Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, Diagnostical and Interventional Neuroradiology, University Hospital of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
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16
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Michiels L, Dobbels L, Demeestere J, Demaerel P, Van Laere K, Lemmens R. Simplified Edinburgh and modified Boston criteria in relation to amyloid PET for lobar intracerebral hemorrhage. NEUROIMAGE: CLINICAL 2022; 35:103107. [PMID: 35853346 PMCID: PMC9421490 DOI: 10.1016/j.nicl.2022.103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/28/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022] Open
Abstract
Amyloid PET was positive in 63% of patients with lobar ICH. Simplified Edinburgh criteria and amyloid PET have similar accuracy vs Boston criteria. Simplified Edinburgh and Boston criteria have similar accuracy vs amyloid PET. Amyloid PET could assist in diagnosing CAA.
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.
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17
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Chang Y, Liu J, Wang L, Li X, Wang Z, Lin M, Jin W, Zhu M, Xu B. Diagnostic Utility of Integrated 11C-Pittsburgh Compound B Positron Emission Tomography/Magnetic Resonance for Cerebral Amyloid Angiopathy: A Pilot Study. Front Aging Neurosci 2021; 13:721780. [PMID: 34899265 PMCID: PMC8660657 DOI: 10.3389/fnagi.2021.721780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We aimed to compare amyloid deposition at the lobar cerebral microbleed (CMB) sites of cerebral amyloid angiopathy (CAA), Alzheimer’s disease (AD), and cognitively normal healthy controls (NC) and to propose a novel diagnostic method for differentiating CAA patients from AD patients with integrated 11C-Pittsburgh compound B (PIB) positron emission tomography (PET)/magnetic resonance (MR) and assess its diagnostic value. Methods: Nine CAA, 15 AD patients, and 15 NC subjects were enrolled in this study. Each subject underwent an 11C-PIB brain PET/MR examination. Susceptibility weighted imaging was assessed to detect CMB locations, and standardized uptake value ratios (SUVRs) were measured at these sites. Cortical PIB distributions were quantitatively evaluated. Patients with CAA, AD, and NC subjects were compared with global and regional cortical SUVRs at CMB cites. The diagnostic accuracy of MRI, PIB-PET, and PET/MR in differentiating CAA and AD was evaluated. Results: Lobar CMBs were detected in all the CAA patients, eight of the 15 AD patients (53.3%), and four of the 15 NC subjects (26.7%), respectively. The PIB deposition at CMB sites was significantly higher in CAA patients compared with AD patients and NC subjects in terms of SUVR (1.72 ± 0.10 vs. 1.42 ± 0.16 and 1.17 ± 0.08; p < 0.0001). The PIB deposition was associated with CMB locations and was greatest in the occipital and temporal regions of CAA patients. The global cortical PIB deposition was significantly higher in CAA than in NC subjects (1.66 ± 0.06 vs. 1.21 ± 0.06; p < 0.0001) and significantly lower than in AD patients (1.66 ± 0.06 vs. 1.86 ± 0.17; p < 0.0001). In contrast, the occipital/global PIB uptake ratio was significantly increased in CAA (occipital/global ratio, 1.05 ± 0.02) relative to AD patients (1.05 ± 0.02 vs. 0.99 ± 0.04; p < 0.001). PET/MR had a higher accuracy (sensitivity, 88.9%; specificity, 93.3%) than separate PET and MR. Conclusion: Our results indicate that the CMBs occur preferentially at loci with concentrated amyloid. By combining lobar CMBs with regional cortical amyloid deposition, the proposed workflow can further improve CAA diagnostic accuracy compared to each method alone. These findings improve our knowledge regarding the pathogenesis of CMBs and highlight the potential utility of PIB-PET/MR as a non-invasive tool for distinguishing CAA and AD patients.
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Affiliation(s)
- Yan Chang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Liang Wang
- PET/CT, Jixi Ji Mine Hospital, Jixi, China
| | - Xin Li
- Department of Interventional Radiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhenjun Wang
- Department of Radiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mu Lin
- MR Collaboration, Diagnostic Imaging, Siemens Healthcare Ltd., Shanghai, China
| | - Wei Jin
- Department of Pathology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingwei Zhu
- Department of Neurology Medicine, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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18
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Zhang Q, Zhao X, Lei P, Kung HF, Yang Z, Zhu L, Wang S, Zhu H, Meng X, Duan Y, Sun L, Pan J, Ma R, Hong H, Zhao X, Demchuk A, Smith EE, Wang Y. Evaluating [ 68Ga]Ga-p14-032 as a Novel PET Tracer for Diagnosis Cerebral Amyloid Angiopathy. Front Neurol 2021; 12:702185. [PMID: 34777194 PMCID: PMC8580011 DOI: 10.3389/fneur.2021.702185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: We aimed to investigate the distribution of [68Ga]Ga-p14-032, a novel PET ligand that binds to vascular amyloid, in patients diagnosed clinically with probable cerebral amyloid angiopathy (CAA) compared with patients with Alzheimer's disease (AD) and normal controls (NC). Methods: This longitudinal cohort study was composed of 10 subjects (three probable CAA patients, two AD patients, five NC subjects), recruited from a clinic in China. CAA patients had a history of lobar intracerebral hemorrhage (ICH) and met modified Boston criteria for probable CAA. All participants were aged at least 55 years and underwent [68Ga] Ga-p14-032 PET/CT or/and PET/MRI, and the Montreal Cognitive Assessment on initial assessment. Demographics were measured at baseline (diabetes, hypertension, hypercholesterolemia, ischemic stroke, and ICH). Two PET imaging experts reviewed the PET images with cortical standardized uptake value ratio (SUVr) displayed on a color scale and visually classified the images as positive or negative. The mean of SUVr was calculated using the pons as reference. Results: In CAA patients, PET scans were positive in regions with higher numbers of CMBs. No significant signal was seen in AD subjects or controls. The relative [68Ga]Ga-p14-032 retention in the cortex was stronger in patients with CAA than AD and NC (median SUVr 2.68 ± 1.53 vs. 1.77 ± 0.08 and 0.83 ± 0.24). Conclusions: Our results provide early evidence that the [68Ga] Ga-p14-032 PET probe binds preferentially to vascular amyloid and may be a useful tracer for diagnosing CAA.
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Affiliation(s)
- Qihui Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaobin Zhao
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Lei
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Hank F Kung
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital, Beijing, China
| | - Lin Zhu
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, China
| | - Shujing Wang
- Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital, Beijing, China
| | - Hua Zhu
- Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital, Beijing, China
| | - Xiangxi Meng
- Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital, Beijing, China
| | - Yunyun Duan
- Department of Medical Imaging, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Sun
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Jianwei Pan
- Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ruixue Ma
- Department of Neurology, DongFang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haiyan Hong
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Andrew Demchuk
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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19
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McCarter SJ, Lesnick TG, Lowe V, Mielke MM, Constantopoulos E, Rabinstein AA, Przybelski SA, Botha H, Jones DT, Ramanan VK, Jack CR, Petersen RC, Knopman D, Boeve BF, Murray ME, Dickson DW, Vemuri P, Kantarci K, Reichard RR, Graff-Radford J. Cerebral Amyloid Angiopathy Pathology and Its Association With Amyloid-β PET Signal. Neurology 2021; 97:e1799-e1808. [PMID: 34504022 PMCID: PMC8610626 DOI: 10.1212/wnl.0000000000012770] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the contribution of cerebral amyloid angiopathy (CAA) to Pittsburgh compound B (PiB)-PET tracer retention. METHODS Participants from the Mayo Clinic Study of Aging and Mayo Clinic Alzheimer's Disease Research Center with antemortem PiB-PET imaging for β-amyloid (Aβ) who later underwent autopsy were included in this study. Pathologic regional leptomeningeal, parenchymal, capillary CAA, and Aβ plaque burden were calculated from one hemisphere. Regional lobar amyloid standardized uptake value ratio (SUVR) on PET was calculated from the same hemisphere sampled at autopsy. Single- and multiple-predictor linear regression models were used to evaluate the relative contributions of pathologically determined regional CAA and Aβ plaques to antemortem PiB-PET SUVR. RESULTS Forty-one participants (30 male, 11 female) with a mean (SD) age at death of 75.7 (10.6) years were included. Twenty-seven (66%) had high PiB signal with a mean (SD) of 2.3 (1.2) years from time of PET scan to death; 24 (59%) had a pathologic diagnosis of Alzheimer disease. On multivariate analysis, CAA was not associated with PiB-PET SUVR, while plaques remained associated with PiB-PET SUVR in all regions (all p < 0.05). In patients without frequent amyloid plaques, CAA was not associated with PiB-PET in any region. DISCUSSION We did not find evidence that pathologically confirmed regional CAA burden contributes significantly to proximal antemortem regional PiB-PET signal, suggesting that amyloid PET imaging for measurement of cortical amyloid burden is unconfounded by CAA on a lobar level. Whether CAA burden contributes to PiB-PET signal in patients with severe CAA phenotypes, such as lobar hemorrhage, requires further investigation.
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Affiliation(s)
- Stuart J McCarter
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL.
| | - Timothy G Lesnick
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Val Lowe
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Michelle M Mielke
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Eleni Constantopoulos
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Alejandro A Rabinstein
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Scott A Przybelski
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Hugo Botha
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - David T Jones
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Vijay K Ramanan
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Clifford R Jack
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Ronald C Petersen
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - David Knopman
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Bradley F Boeve
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Melissa E Murray
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Dennis W Dickson
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Prashanthi Vemuri
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Kejal Kantarci
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - R Ross Reichard
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
| | - Jonathan Graff-Radford
- From the Departments of Neurology (S.M., M.M.M., A.A.R., H.B., D.T.J., V.K.R., R.C.P., D.K., B.F.B., J.G.-R.), Quantitative Health Sciences (T.G.L., M.M.M., S.A.P.), Radiology (V.L., C.R.J., P.V., K.K.), and Pathology and Laboratory Medicine (E.C., R.R.R.), Mayo Clinic, Rochester, MN; and Departments of Neuroscience (M.E.M., D.W.D.) and Pathology and Laboratory Medicine (D.W.D.), Mayo Clinic, Jacksonville, FL
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20
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Chen CD, Joseph-Mathurin N, Sinha N, Zhou A, Li Y, Friedrichsen K, McCullough A, Franklin EE, Hornbeck R, Gordon B, Sharma V, Cruchaga C, Goate A, Karch C, McDade E, Xiong C, Bateman RJ, Ghetti B, Ringman JM, Chhatwal J, Masters CL, McLean C, Lashley T, Su Y, Koeppe R, Jack C, Klunk WE, Morris JC, Perrin RJ, Cairns NJ, Benzinger TLS. Comparing amyloid-β plaque burden with antemortem PiB PET in autosomal dominant and late-onset Alzheimer disease. Acta Neuropathol 2021; 142:689-706. [PMID: 34319442 PMCID: PMC8815340 DOI: 10.1007/s00401-021-02342-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/31/2022]
Abstract
Pittsburgh compound B (PiB) radiotracer for positron emission tomography (PET) imaging can bind to different types of amyloid-β plaques and blood vessels (cerebral amyloid angiopathy). However, the relative contributions of different plaque subtypes (diffuse versus cored/compact) to in vivo PiB PET signal on a region-by-region basis are incompletely understood. Of particular interest is whether the same staging schemes for summarizing amyloid-β burden are appropriate for both late-onset and autosomal dominant forms of Alzheimer disease (LOAD and ADAD). Here, we compared antemortem PiB PET with follow-up postmortem estimation of amyloid-β burden using stereologic methods to estimate the relative area fraction of diffuse and cored/compact amyloid-β plaques across 16 brain regions in 15 individuals with ADAD and 14 individuals with LOAD. In ADAD, we found that PiB PET correlated with diffuse plaques in the frontal, parietal, temporal, and striatal regions commonly used to summarize amyloid-β burden in PiB PET, and correlated with both diffuse and cored/compact plaques in the occipital lobe and parahippocampal gyrus. In LOAD, we found that PiB PET correlated with both diffuse and cored/compact plaques in the anterior cingulate, frontal lobe (middle frontal gyrus), and parietal lobe, and showed additional correlations with diffuse plaque in the amygdala and occipital lobe, and with cored/compact plaque in the temporal lobe. Thus, commonly used PiB PET summary regions predominantly reflect diffuse plaque burden in ADAD and a mixture of diffuse and cored/compact plaque burden in LOAD. In direct comparisons of ADAD and LOAD, postmortem stereology identified much greater mean amyloid-β plaque burdens in ADAD versus LOAD across almost all brain regions studied. However, standard PiB PET did not recapitulate these stereologic findings, likely due to non-trivial amyloid-β plaque burdens in ADAD within the cerebellum and brainstem-commonly used reference regions in PiB PET. Our findings suggest that PiB PET summary regions correlate with amyloid-β plaque burden in both ADAD and LOAD; however, they might not be reliable in direct comparisons of regional amyloid-β plaque burden between the two forms of AD.
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Affiliation(s)
- Charles D Chen
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Nelly Joseph-Mathurin
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Namita Sinha
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Pathology, University of Manitoba, Shared Health, Winnipeg, MB, Canada
| | - Aihong Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Karl Friedrichsen
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Austin McCullough
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Erin E Franklin
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Russ Hornbeck
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian Gordon
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Vijay Sharma
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Alison Goate
- Department of Genetics and Genomic Sciences, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Celeste Karch
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Eric McDade
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Chengjie Xiong
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall J Bateman
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John M Ringman
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jasmeer Chhatwal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Colin L Masters
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Catriona McLean
- Department of Anatomic Pathology, Alfred Hospital, Melbourne, VIC, Australia
| | - Tammaryn Lashley
- UCL Queen Square Institute of Neurology, University College London, London, UK
- Queen Square Brain Bank for Neurological Disorders, University College London, London, UK
| | - Yi Su
- Banner Alzheimer's Institute, Banner Health, Phoenix, AZ, USA
- Arizona Alzheimer's Consortium, Banner Health, Phoenix, AZ, USA
| | - Robert Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Clifford Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - William E Klunk
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - John C Morris
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Richard J Perrin
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Nigel J Cairns
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tammie L S Benzinger
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA.
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21
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Tsai HH, Chen YF, Yen RF, Lo YL, Yang KC, Jeng JS, Tsai LK, Chang CF. Plasma soluble TREM2 is associated with white matter lesions independent of amyloid and tau. Brain 2021; 144:3371-3380. [PMID: 34515756 DOI: 10.1093/brain/awab332] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/21/2021] [Accepted: 08/08/2021] [Indexed: 12/20/2022] Open
Abstract
Cerebral small vessel disease is one of the most common causes of cognitive decline and stroke. While several lines of evidence have established a relationship between inflammation and cerebrovascular pathology, the mechanistic link has not yet been elucidated. Recent studies suggest activation of immune mediators, including the soluble form of triggering receptor expressed on myeloid cells 2 (TREM2), may be critical regulators. In this study, we compared the plasma levels of soluble TREM2 and its correlations with neuroimaging markers and cerebral amyloid load in ten patients with Alzheimer's disease and 66 survivors of spontaneous intracerebral haemorrhage with cerebral amyloid angiopathy or hypertensive small vessel disease, two of the most common types of sporadic small vessel disease. We performed brain MRI and 11C-Pittsburgh compound B PET for all participants to evaluate radiological small vessel disease markers and cerebral amyloid burden, and 18F-T807 PET in a subgroup of patients to evaluate cortical tau pathology. Plasma soluble TREM2 levels were comparable between patients with Alzheimer's disease and small vessel disease (P=0.690). In patients with small vessel disease, plasma soluble TREM2 was significantly associated with white matter hyperintensity volume (P<0.001), but not with cerebral amyloid load. Among patients with Alzheimer's disease and cerebral amyloid angiopathy, plasma soluble TREM2 was independently associated with a tau-positive scan (P=0.001) and white matter hyperintensity volume (P=0.013), but not amyloid load (P=0.221). Our results indicate plasma soluble TREM2 is associated with white matter hyperintensity independent of amyloid and tau pathology. These findings highlight the potential utility of plasma soluble TREM2 as a strong predictive marker for small vessel disease-related white matter injury and hold clinical implications for targeting the innate immune response when treating this disease.
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Affiliation(s)
- Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan.,Department of Neurology, 3Medical Imaging, and 4Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Fang Chen
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department and Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Ling Lo
- Department of Neurology, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Kai-Chien Yang
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, 3Medical Imaging, and 4Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, 3Medical Imaging, and 4Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Che-Feng Chang
- Department and Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
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22
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Ulivi L, Cosottini M, Migaleddu G, Orlandi G, Giannini N, Siciliano G, Mancuso M. Brain MRI in Monogenic Cerebral Small Vessel Diseases: A Practical Handbook. Curr Mol Med 2021; 22:300-311. [DOI: 10.2174/1566524021666210510164003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 11/22/2022]
Abstract
:
Monogenic cerebral small vessel diseases are a topic of growing interest, as several genes responsible have been recently described and new sequencing techniques such as Next generation sequencing are available. Brain imaging is a key exam in these diseases. First, since it is often the first exam performed, an MRI is key in selecting patients for genetic testing and for interpreting Next generation sequencing reports. In addition, neuroimaging can be helpful in describing the underlying pathological mechanisms involved in cerebral small vessel disease. With this review, we aim to provide Neurologists and Stroke physicians with an up-to date overview of the current neuroimaging knowledge on monogenic small vessel diseases.
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Affiliation(s)
- Leonardo Ulivi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gianmichele Migaleddu
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Orlandi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
| | - Nicola Giannini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
| | - Gabriele Siciliano
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
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23
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Banerjee G, Ambler G, Keshavan A, Paterson RW, Foiani MS, Toombs J, Heslegrave A, Dickson JC, Fraioli F, Groves AM, Lunn MP, Fox NC, Zetterberg H, Schott JM, Werring DJ. Cerebrospinal Fluid Biomarkers in Cerebral Amyloid Angiopathy. J Alzheimers Dis 2021; 74:1189-1201. [PMID: 32176643 PMCID: PMC7242825 DOI: 10.3233/jad-191254] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: There is limited data on cerebrospinal fluid (CSF) biomarkers in sporadic amyloid-β (Aβ) cerebral amyloid angiopathy (CAA). Objective: To determine the profile of biomarkers relevant to neurodegenerative disease in the CSF of patients with CAA. Methods: We performed a detailed comparison of CSF markers, comparing patients with CAA, Alzheimer’s disease (AD), and control (CS) participants, recruited from the Biomarkers and Outcomes in CAA (BOCAA) study, and a Specialist Cognitive Disorders Service. Results: We included 10 CAA, 20 AD, and 10 CS participants (mean age 68.6, 62.5, and 62.2 years, respectively). In unadjusted analyses, CAA patients had a distinctive CSF biomarker profile, with significantly lower (p < 0.01) median concentrations of Aβ38, Aβ40, Aβ42, sAβPPα, and sAβPPβ. CAA patients had higher levels of neurofilament light (NFL) than the CS group (p < 0.01), but there were no significant differences in CSF total tau, phospho-tau, soluble TREM2 (sTREM2), or neurogranin concentrations. AD patients had higher total tau, phospho-tau and neurogranin than CS and CAA groups. In age-adjusted analyses, differences for the CAA group remained for Aβ38, Aβ40, Aβ42, and sAβPPβ. Comparing CAA patients with amyloid-PET positive (n = 5) and negative (n = 5) scans, PET positive individuals had lower (p < 0.05) concentrations of CSF Aβ42, and higher total tau, phospho-tau, NFL, and neurogranin concentrations, consistent with an “AD-like” profile. Conclusion: CAA has a characteristic biomarker profile, suggestive of a global, rather than selective, accumulation of amyloid species; we also provide evidence of different phenotypes according to amyloid-PET positivity. Further replication and validation of these preliminary findings in larger cohorts is needed.
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Affiliation(s)
- Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Ross W Paterson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martha S Foiani
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Jamie Toombs
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - John C Dickson
- Institute of Nuclear Medicine, UCL and University College Hospital, London, UK
| | - Francesco Fraioli
- Institute of Nuclear Medicine, UCL and University College Hospital, London, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, UCL and University College Hospital, London, UK
| | - Michael P Lunn
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Salhgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
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24
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Tsai HH, Pasi M, Tsai LK, Huang CC, Chen YF, Lee BC, Yen RF, Gurol ME, Jeng JS. Centrum Semiovale Perivascular Space and Amyloid Deposition in Spontaneous Intracerebral Hemorrhage. Stroke 2021; 52:2356-2362. [PMID: 33874751 DOI: 10.1161/strokeaha.120.032139] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei (H.-H.T.).,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei (H.-H.T.).,Department of Neurology (H.-H.T., L.-K.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (M.P.)
| | - Li-Kai Tsai
- Department of Neurology (H.-H.T., L.-K.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Chi-Ching Huang
- School of Medicine, College of Medicine, National Taiwan University, Taipei (C.-C.H.)
| | - Ya-Fang Chen
- Department of Medical Imaging (Y.-F.C., B.-C.L.), National Taiwan University Hospital, Taipei
| | - Bo-Ching Lee
- Department of Medical Imaging (Y.-F.C., B.-C.L.), National Taiwan University Hospital, Taipei
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.E.G.)
| | - Jiann-Shing Jeng
- Department of Neurology (H.-H.T., L.-K.T., J.-S.J.), National Taiwan University Hospital, Taipei
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25
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Abstract
Alzheimer's disease (AD) is the most common cause of dementia and accounts for approximately 50% to 80% of all cases of dementia. The diagnosis of probable AD is based on clinical criteria and overlapping clinical features pose a challenge to accurate diagnosis. However, neuroimaging has been included as a biomarker in various published criteria for the diagnosis of probable AD, in the absence of a confirmatory diagnostic test during life. Advances in neuroimaging techniques and their inclusion in diagnostic and research criteria for the diagnosis of AD includes the use of positron emission tomography (PET) imaging as a biomarker in various therapeutic and prognostic studies in AD. The development and application of a range of PET tracers will allow more detailed assessment of people with AD and will improve diagnostic specificity and targeted therapy of AD. The aim of this review is to summarize current evidence on PET imaging using the non-specific tracer [18F]fluorodeoxyglucose and specific tracers that target amyloid and tau pathology in people with AD.
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Affiliation(s)
- Shailendra Mohan Tripathi
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Alison D Murray
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
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26
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Kelly J. New horizons: managing antithrombotic dilemmas in patients with cerebral amyloid angiopathy. Age Ageing 2021; 50:347-355. [PMID: 33480964 DOI: 10.1093/ageing/afaa275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 11/14/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) most commonly presents with lobar intracerebral haemorrhage, though also with transient focal neurological episodes, cognitive impairment, as an incidental finding and rarely acutely or subacutely in patients developing an immune response to amyloid. Convexity subarachnoid haemorrhage, cortical superficial siderosis and lobar cerebral microbleeds are the other signature imaging features. The main implications of a diagnosis are the risk of intracerebral haemorrhage and frequent co-existence of antithrombotic indications. The risk of intracerebral haemorrhage varies by phenotype, being highest in patients with transient focal neurological episodes and lowest in patients with isolated microbleeds. There is only one relevant randomised controlled trial to CAA patients with antithrombotic indications: RESTART showed that in patients presenting with intracerebral haemorrhage while taking antiplatelets, restarting treatment appeared to reduce recurrent intracerebral haemorrhage and improve outcomes. Observational and indirect data are reviewed relevant to other scenarios where there are antithrombotic indications. In patients with a microbleed-only phenotype, the risk of ischaemic stroke exceeds the risk of intracerebral haemorrhage at all cerebral microbleed burdens. In patients with atrial fibrillation (AF), left atrial appendage occlusion, where device closure excludes the left atrial appendage from the circulation, can be considered where the risk of anticoagulation seems prohibitive. Ongoing trials are testing the role of direct oral anticoagulant (DOACs) and left atrial appendage occlusion in patients with intracerebral haemorrhage/AF but in the interim, treatment decisions will need to be individualised and remain difficult.
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Affiliation(s)
- James Kelly
- Hampshire Hospital Foundation Trust, Department of Elderly Care, Royal Hampshire County Hospital, Winchester, Hampshire, UK
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27
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Schoemaker D, Charidimou A, Zanon Zotin MC, Raposo N, Johnson KA, Sanchez JS, Greenberg SM, Viswanathan A. Association of Memory Impairment With Concomitant Tau Pathology in Patients With Cerebral Amyloid Angiopathy. Neurology 2021; 96:e1975-e1986. [PMID: 33627498 DOI: 10.1212/wnl.0000000000011745] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Relying on tau-PET imaging, this cross-sectional study explored whether memory impairment is linked to the presence of concomitant tau pathology in individuals with cerebral amyloid angiopathy (CAA). METHODS Forty-six patients with probable CAA underwent a neuropsychological examination and an MRI for quantification of structural markers of cerebral small vessel disease. A subset of these participants also completed a [11C]-Pittsburgh compound B (n = 39) and [18F]-flortaucipir (n = 40) PET for in vivo estimation of amyloid and tau burden, respectively. Participants were classified as amnestic or nonamnestic on the basis of neuropsychological performance. Statistical analyses were performed to examine differences in cognition, structural markers of cerebral small vessel disease, and amyloid- and tau-PET retention between participants with amnestic and those with nonamnestic CAA. RESULTS Patients with probable CAA with an amnestic presentation displayed a globally more severe profile of cognitive impairment, smaller hippocampal volume (p < 0.001), and increased tau-PET binding in regions susceptible to Alzheimer disease neurodegeneration (p = 0.003) compared to their nonamnestic counterparts. Amnestic and nonamnestic patients with CAA did not differ on any other MRI markers or on amyloid-PET binding. In a generalized linear model including all evaluated neuroimaging markers, tau-PET retention (β = -0.85, p = 0.001) and hippocampal volume (β = 0.64 p = 0.01) were the only significant predictors of memory performance. The cognitive profile of patients with CAA with an elevated tau-PET retention was distinctly characterized by a significantly lower performance on the memory domain (p = 0.004). CONCLUSIONS These results suggest that the presence of objective memory impairment in patients with probable CAA could serve as a marker for underlying tau pathology. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that tau-PET retention is related to the presence of objective memory impairment in patients with CAA.
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Affiliation(s)
- Dorothee Schoemaker
- From the Departments of Psychiatry (D.S.), Neurology (A.C., M.C.Z.Z., K.A.J., J.S.S., S.M.G., A.V.), and Radiology (K.A.J., J.S.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), France. M.C.Z.Z. is currently at the Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil; N.R. is at Toulouse Neuroimaging Center, Université de Toulouse, INSERM, UPS, France; and K.A.J. is at the Department of Neurology, Brigham and Women's Hospital, Boston.
| | - Andreas Charidimou
- From the Departments of Psychiatry (D.S.), Neurology (A.C., M.C.Z.Z., K.A.J., J.S.S., S.M.G., A.V.), and Radiology (K.A.J., J.S.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), France. M.C.Z.Z. is currently at the Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil; N.R. is at Toulouse Neuroimaging Center, Université de Toulouse, INSERM, UPS, France; and K.A.J. is at the Department of Neurology, Brigham and Women's Hospital, Boston
| | - Maria Clara Zanon Zotin
- From the Departments of Psychiatry (D.S.), Neurology (A.C., M.C.Z.Z., K.A.J., J.S.S., S.M.G., A.V.), and Radiology (K.A.J., J.S.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), France. M.C.Z.Z. is currently at the Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil; N.R. is at Toulouse Neuroimaging Center, Université de Toulouse, INSERM, UPS, France; and K.A.J. is at the Department of Neurology, Brigham and Women's Hospital, Boston
| | - Nicolas Raposo
- From the Departments of Psychiatry (D.S.), Neurology (A.C., M.C.Z.Z., K.A.J., J.S.S., S.M.G., A.V.), and Radiology (K.A.J., J.S.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), France. M.C.Z.Z. is currently at the Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil; N.R. is at Toulouse Neuroimaging Center, Université de Toulouse, INSERM, UPS, France; and K.A.J. is at the Department of Neurology, Brigham and Women's Hospital, Boston
| | - Keith A Johnson
- From the Departments of Psychiatry (D.S.), Neurology (A.C., M.C.Z.Z., K.A.J., J.S.S., S.M.G., A.V.), and Radiology (K.A.J., J.S.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), France. M.C.Z.Z. is currently at the Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil; N.R. is at Toulouse Neuroimaging Center, Université de Toulouse, INSERM, UPS, France; and K.A.J. is at the Department of Neurology, Brigham and Women's Hospital, Boston
| | - Justin S Sanchez
- From the Departments of Psychiatry (D.S.), Neurology (A.C., M.C.Z.Z., K.A.J., J.S.S., S.M.G., A.V.), and Radiology (K.A.J., J.S.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), France. M.C.Z.Z. is currently at the Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil; N.R. is at Toulouse Neuroimaging Center, Université de Toulouse, INSERM, UPS, France; and K.A.J. is at the Department of Neurology, Brigham and Women's Hospital, Boston
| | - Steven M Greenberg
- From the Departments of Psychiatry (D.S.), Neurology (A.C., M.C.Z.Z., K.A.J., J.S.S., S.M.G., A.V.), and Radiology (K.A.J., J.S.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), France. M.C.Z.Z. is currently at the Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil; N.R. is at Toulouse Neuroimaging Center, Université de Toulouse, INSERM, UPS, France; and K.A.J. is at the Department of Neurology, Brigham and Women's Hospital, Boston
| | - Anand Viswanathan
- From the Departments of Psychiatry (D.S.), Neurology (A.C., M.C.Z.Z., K.A.J., J.S.S., S.M.G., A.V.), and Radiology (K.A.J., J.S.S.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse (University Hospital Centre), France. M.C.Z.Z. is currently at the Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Brazil; N.R. is at Toulouse Neuroimaging Center, Université de Toulouse, INSERM, UPS, France; and K.A.J. is at the Department of Neurology, Brigham and Women's Hospital, Boston
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Bergeret S, Queneau M, Rodallec M, Curis E, Dumurgier J, Hugon J, Paquet C, Farid K, Baron JC. [ 18 F]FDG PET may differentiate cerebral amyloid angiopathy from Alzheimer's disease. Eur J Neurol 2021; 28:1511-1519. [PMID: 33460498 DOI: 10.1111/ene.14743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is a frequent cause of both intracerebral hemorrhage (ICH) and cognitive impairment in the elderly. Diagnosis relies on the Boston criteria, which use magnetic resonance imaging markers including ≥2 exclusively lobar cerebral microbleeds (lCMBs). Although amyloid positron emission tomography (PET) may provide molecular diagnosis, its specificity relative to Alzheimer's disease (AD) is limited due to the prevalence of positive amyloid PET in cognitively normal elderly. Using early-phase 11 C-Pittsburgh compound B as surrogate for tissue perfusion, a significantly lower occipital/posterior cingulate (O/PC) tracer uptake ratio in probable CAA relative to AD was recently reported, consistent with histopathological lesion distribution. We tested whether this finding could be reproduced using [18 F]fluorodeoxyglucose (FDG)-PET, a widely available modality that correlates well with early-phase amyloid PET in both healthy subjects and AD. METHODS From a large memory clinic database, we retrospectively included 14 patients with probable CAA (Boston criteria) and 21 patients with no lCMB fulfilling AD criteria including cerebrospinal fluid biomarkers. In all, [18 F]FDG-PET/computed tomography (CT) was available as part of routine care. No subject had a clinical history of ICH. Regional standardized [18 F]FDG uptake values normalized to the pons (standard uptake value ratio [SUVr]) were obtained, and the O/PC ratio was calculated. RESULTS The SUVr O/PC ratio was significantly lower in CAA versus AD (1.02 ± 0.14 vs. 1.19 ± 0.18, respectively; p = 0.024). CONCLUSIONS Despite the small sample, our findings are consistent with the previous early-phase amyloid PET study. Thus, [18 F]FDG-PET may help differentiate CAA from AD, particularly in cases of amyloid PET positivity. Larger prospective studies, including in CAA-related ICH, are however warranted.
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Affiliation(s)
- Sébastien Bergeret
- Department of Nuclear Medicine, CHU French West Indies, Fort-de-France, France
| | - Mathieu Queneau
- Department of Nuclear Medicine, Centre Cardiologique du Nord, Saint-Denis, France
| | - Mathieu Rodallec
- Department of Radiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Emmanuel Curis
- Laboratoire de Biomathématiques, EA 7537 "BioSTM", Faculté de Pharmacie, Université de Paris, Paris, France.,Service de Biostatistiques et d'Information Médicale, Hôpital Saint-Louis, APHP, Paris, France
| | - Julien Dumurgier
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France
| | - Jacques Hugon
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France.,Cognitive Neurology Center, APHP, Saint-Louis Lariboisière Fernand-Widal Hospital Group, Paris, France
| | - Claire Paquet
- INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France.,Cognitive Neurology Center, APHP, Saint-Louis Lariboisière Fernand-Widal Hospital Group, Paris, France
| | - Karim Farid
- Department of Nuclear Medicine, CHU French West Indies, Fort-de-France, France.,INSERM UMR-S 1144: Therapeutic Optimization in Neuropsychopharmacology, Université de Paris, Paris, France
| | - Jean-Claude Baron
- Department of Neurology, Sainte-Anne Hospital, Université de Paris, Paris, France.,INSERM U1266: Institut de Psychiatrie et Neurosciences de Paris, Université de Paris, Paris, France
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29
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Jung YH, Jang H, Park SB, Choe YS, Park Y, Kang SH, Lee JM, Kim JS, Kim J, Kim JP, Kim HJ, Na DL, Seo SW. Strictly Lobar Microbleeds Reflect Amyloid Angiopathy Regardless of Cerebral and Cerebellar Compartments. Stroke 2020; 51:3600-3607. [PMID: 33198580 DOI: 10.1161/strokeaha.119.028487] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to determine whether lobar cerebellar microbleeds or concomitant lobar cerebellar and deep microbleeds, in the presence of lobar cerebral microbleeds, attribute to underlying advanced cerebral amyloid angiopathy pathology or hypertensive arteriopathy. METHODS We categorized 71 patients with suspected cerebral amyloid angiopathy markers (regardless of the presence of deep and cerebellar microbleeds) into 4 groups according to microbleed distribution: L (strictly lobar cerebral, n=33), L/LCbll (strictly lobar cerebral and strictly lobar cerebellar microbleeds, n=13), L/Cbll/D (lobar, cerebellar, and deep microbleeds, n=17), and L/D (lobar and deep, n=8). We additionally categorized patients with cerebellar microbleeds into 2 groups according to dentate nucleus involvement: strictly lobar cerebellar (n=16) and dentate (n=14). We then compared clinical characteristics, Aβ (amyloid-β) positivity on PET (positron emission tomography), magnetic resonance imaging cerebral amyloid angiopathy markers, and cerebral small vessel disease burden among groups. RESULTS The frequency of Aβ positivity was higher in the L and L/LCbll groups (81.8% and 84.6%) than in the L/Cbll/D and L/D groups (37.5% and 29.4%; P<0.001), while lacune numbers were lower in the L and L/LCbll groups (1.7±3.3 and 1.7±2.6) than in the L/Cbll/D and L/D groups (8.0±10.3 and 13.4±17.7, P=0.001). The L/LCbll group had more lobar cerebral microbleeds than the L group (93.2±121.8 versus 38.0±40.8, P=0.047). The lobar cerebellar group had a higher Aβ positivity (75% versus 28.6%, P=0.011) and lower lacune number (2.3±3.7 versus 8.6±1.2, P=0.041) than the dentate group. CONCLUSIONS Strictly lobar cerebral and cerebellar microbleeds are related to cerebral amyloid angiopathy, whereas any combination of concurrent lobar and deep microbleeds suggest hypertensive angiopathy regardless of cerebral or cerebellar compartments.
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Affiliation(s)
- Young Hee Jung
- Department of Neurology, Myongji Hospital, Hanyang University, Goyang, Korea (Y.H.J)
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.)
| | - Seong Beom Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.)
| | | | | | - Sung Hoon Kang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.)
| | - Jong Min Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.)
| | - Ji Sun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.)
| | - Jaeho Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.)
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.)
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.)
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea (D.L.N.)
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Neuroscience Center, Samsung Medical Center, Samsung Alzheimer Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea (H.J., S.B.P., S.H.K., J.M.L., J.S.K., J.K., J.P.K., H.J.K., D.L.N., S.W.S.).,Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Korea (S.W.S.).,Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea (S.W.S.)
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30
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Papanastasiou G, Rodrigues MA, Wang C, Heurling K, Lucatelli C, Salman RAS, Wardlaw JM, van Beek EJR, Thompson G. Pharmacokinetic modelling for the simultaneous assessment of perfusion and 18F-flutemetamol uptake in cerebral amyloid angiopathy using a reduced PET-MR acquisition time: Proof of concept. Neuroimage 2020; 225:117482. [PMID: 33157265 DOI: 10.1016/j.neuroimage.2020.117482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/24/2020] [Accepted: 10/19/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease associated with perivascular β-amyloid deposition. CAA is also associated with strokes due to lobar intracerebral haemorrhage (ICH). 18F-flutemetamol amyloid ligand PET may improve the early detection of CAA. We performed pharmacokinetic modelling using both full (0-30, 90-120 min) and reduced (30 min) 18F-flutemetamol PET-MR acquisitions, to investigate regional cerebral perfusion and amyloid deposition in ICH patients. METHODS Dynamic18F-flutemetamol PET-MR was performed in a pilot cohort of sixteen ICH participants; eight lobar ICH cases with probable CAA and eight deep ICH patients. A model-based input function (mIF) method was developed for compartmental modelling. mIF 1-tissue (1-TC) and 2-tissue (2-TC) compartmental modelling, reference tissue models and standardized uptake value ratios were assessed in the setting of probable CAA detection. RESULTS The mIF 1-TC model detected perfusion deficits and 18F-flutemetamol uptake in cases with probable CAA versus deep ICH patients, in both full and reduced PET acquisition time (all P < 0.05). In the reduced PET acquisition, mIF 1-TC modelling reached the highest sensitivity and specificity in detecting perfusion deficits (0.87, 0.77) and 18F-flutemetamol uptake (0.83, 0.71) in cases with probable CAA. Overall, 52 and 48 out of the 64 brain areas with 18F-flutemetamol-determined amyloid deposition showed reduced perfusion for 1-TC and 2-TC models, respectively. CONCLUSION Pharmacokinetic (1-TC) modelling using a 30 min PET-MR time frame detected impaired haemodynamics and increased amyloid load in probable CAA. Perfusion deficits and amyloid burden co-existed within cases with CAA, demonstrating a distinct imaging pattern which may have merit in elucidating the pathophysiological process of CAA.
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Affiliation(s)
- Giorgos Papanastasiou
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Chengjia Wang
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | | | - Christophe Lucatelli
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | | | - Joanna M Wardlaw
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Gerard Thompson
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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31
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Schreiber S, DiFrancesco JC. Impaired occipital cerebrovascular reactivity as a biomarker for vascular β-amyloid. Neurology 2020; 95:415-416. [DOI: 10.1212/wnl.0000000000010207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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32
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Baldacci F, Mazzucchi S, Della Vecchia A, Giampietri L, Giannini N, Koronyo-Hamaoui M, Ceravolo R, Siciliano G, Bonuccelli U, Elahi FM, Vergallo A, Lista S, Giorgi FS. The path to biomarker-based diagnostic criteria for the spectrum of neurodegenerative diseases. Expert Rev Mol Diagn 2020; 20:421-441. [PMID: 32066283 PMCID: PMC7445079 DOI: 10.1080/14737159.2020.1731306] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Introduction: The postmortem examination still represents the reference standard for detecting the pathological nature of chronic neurodegenerative diseases (NDD). This approach displays intrinsic conceptual limitations since NDD represent a dynamic spectrum of partially overlapping phenotypes, shared pathomechanistic alterations that often give rise to mixed pathologies.Areas covered: We scrutinized the international clinical diagnostic criteria of NDD and the literature to provide a roadmap toward a biomarker-based classification of the NDD spectrum. A few pathophysiological biomarkers have been established for NDD. These are time-consuming, invasive, and not suitable for preclinical detection. Candidate screening biomarkers are gaining momentum. Blood neurofilament light-chain represents a robust first-line tool to detect neurodegeneration tout court and serum progranulin helps detect genetic frontotemporal dementia. Ultrasensitive assays and retinal scans may identify Aβ pathology early, in blood and the eye, respectively. Ultrasound also represents a minimally invasive option to investigate the substantia nigra. Protein misfolding amplification assays may accurately detect α-synuclein in biofluids.Expert opinion: Data-driven strategies using quantitative rather than categorical variables may be more reliable for quantification of contributions from pathophysiological mechanisms and their spatial-temporal evolution. A systems biology approach is suitable to untangle the dynamics triggering loss of proteostasis, driving neurodegeneration and clinical evolution.
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Affiliation(s)
- Filippo Baldacci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l’hôpital, Paris, France
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Linda Giampietri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fanny M. Elahi
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Andrea Vergallo
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l’hôpital, Paris, France
- Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, Paris, France
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Simone Lista
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l’hôpital, Paris, France
- Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l’hôpital, Paris, France
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), Pitié-Salpêtrière Hospital, Paris, France
| | - Filippo Sean Giorgi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Discovering the Italian phenotype of cerebral amyloid angiopathy (CAA): the SENECA project. Neurol Sci 2020; 41:2193-2200. [PMID: 32166471 DOI: 10.1007/s10072-020-04306-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is one of the major types of cerebral small vessel disease, and a leading cause of spontaneous intracerebral hemorrhage and cognitive decline in elderly patients. Although increasingly detected, a number of aspects including the pathophysiology, the clinical and neuroradiological phenotype, and the disease course are still under investigation. The incomplete knowledge of the disease limits the implementation of evidence-based guidelines on patient's clinical management and the development of treatments able to prevent or reduce disease progression. The SENECA (SEarchiNg biomarkErs of Cerebral Angiopathy) project is the first Italian multicenter cohort study aimed at better defining the disease natural history and identifying clinical and neuroradiological markers of disease progression. By a multidisciplinary approach and the collection of a large and well-phenotyped series and biorepository of CAA patients, the study is ultimately expected to improve the diagnosis and the knowledge of CAA pathophysiological mechanisms.
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Ii Y, Ishikawa H, Matsuyama H, Shindo A, Matsuura K, Yoshimaru K, Satoh M, Taniguchi A, Matsuda K, Umino M, Maeda M, Tomimoto H. Hypertensive Arteriopathy and Cerebral Amyloid Angiopathy in Patients with Cognitive Decline and Mixed Cerebral Microbleeds. J Alzheimers Dis 2020; 78:1765-1774. [PMID: 33185609 PMCID: PMC11062589 DOI: 10.3233/jad-200992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA) may contribute to the development of mixed cerebral microbleeds (CMBs). Recently, the total small vessel disease (SVD) scores for HA and CAA were proposed, which are determined by a combination of MRI markers to reflect overall severity of these microangiopathies. OBJECTIVE We investigated whether or not total HA-SVD and CAA-SVD scores could be used to predict overlap of HA and CAA in patients with mixed CMBs. METHODS Fifty-three subjects with mixed CMBs were retrospectively analyzed. MRI markers (CMBs, lacunes, perivascular space, white matter hyperintensity [WMH] and cortical superficial siderosis [cSS]) were assessed. The HA-SVD score and CAA-SVD score were obtained for each subject. Anterior or posterior WMH was also assessed using the age-related white matter changes scale. RESULTS The two scores were positively correlated (ρ= 0.449, p < 0.001). The prevalence of lobar dominant CMB distribution (p < 0.001) and lacunes in the centrum semiovale (p < 0.001) and the severity of WMH in the parieto-occipital lobes (p = 0.004) were significantly higher in the high CAA-SVD score group. cSS was found in four patients with high CAA-SVD score who showed lobar-dominant CMB distribution and severe posterior WMH. CONCLUSION Mixed CMBs are mainly due to HA. Assessing both two scores may predict the overlap of HA and CAA in individuals with mixed CMBs. Patients with a high CAA-SVD score may have some degree of advanced CAA, especially when lobar predominant CMBs, severe posterior WMH, lobar lacunes, or cSS are observed.
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Affiliation(s)
- Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kimiko Yoshimaru
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kana Matsuda
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Maki Umino
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
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35
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Thal DR, Ronisz A, Tousseyn T, Rijal Upadhaya A, Balakrishnan K, Vandenberghe R, Vandenbulcke M, von Arnim CAF, Otto M, Beach TG, Lilja J, Heurling K, Chakrabarty A, Ismail A, Buckley C, Smith APL, Kumar S, Farrar G, Walter J. Different aspects of Alzheimer's disease-related amyloid β-peptide pathology and their relationship to amyloid positron emission tomography imaging and dementia. Acta Neuropathol Commun 2019; 7:178. [PMID: 31727169 PMCID: PMC6854805 DOI: 10.1186/s40478-019-0837-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/16/2022] Open
Abstract
Alzheimer’s disease (AD)-related amyloid β-peptide (Aβ) pathology in the form of amyloid plaques and cerebral amyloid angiopathy (CAA) spreads in its topographical distribution, increases in quantity, and undergoes qualitative changes in its composition of modified Aβ species throughout the pathogenesis of AD. It is not clear which of these aspects of Aβ pathology contribute to AD progression and to what extent amyloid positron emission tomography (PET) reflects each of these aspects. To address these questions three cohorts of human autopsy cases (in total n = 271) were neuropathologically and biochemically examined for the topographical distribution of Aβ pathology (plaques and CAA), its quantity and its composition. These parameters were compared with neurofibrillary tangle (NFT) and neuritic plaque pathology, the degree of dementia and the results from [18F]flutemetamol amyloid PET imaging in cohort 3. All three aspects of Aβ pathology correlated with one another, the estimation of Aβ pathology by [18F]flutemetamol PET, AD-related NFT pathology, neuritic plaques, and with the degree of dementia. These results show that one aspect of Aβ pathology can be used to predict the other two, and correlates well with the development of dementia, advancing NFT and neuritic plaque pathology. Moreover, amyloid PET estimates all three aspects of Aβ pathology in-vivo. Accordingly, amyloid PET-based estimates for staging of amyloid pathology indicate the progression status of amyloid pathology in general and, in doing so, also of AD pathology. Only 7.75% of our cases deviated from this general association.
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36
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Schultz AP, Kloet RW, Sohrabi HR, van der Weerd L, van Rooden S, Wermer MJH, Moursel LG, Yaqub M, van Berckel BNM, Chatterjee P, Gardener SL, Taddei K, Fagan AM, Benzinger TL, Morris JC, Sperling R, Johnson K, Bateman RJ, Gurol ME, van Buchem MA, Martins R, Chhatwal JP, Greenberg SM. Amyloid imaging of dutch-type hereditary cerebral amyloid angiopathy carriers. Ann Neurol 2019; 86:616-625. [PMID: 31361916 DOI: 10.1002/ana.25560] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether amyloid imaging with the positron emission tomography (PET) agent Pittsburgh compound B (PiB) can detect vascular β-amyloid (Aβ) in the essentially pure form of cerebral amyloid angiopathy associated with the Dutch-type hereditary cerebral amyloid angiopathy (D-CAA) mutation. METHODS PiB retention in a cortical composite of frontal, lateral, and retrosplenial regions (FLR) was measured by PiB-PET in 19 D-CAA mutation carriers (M+ ; 13 without neurologic symptoms, 6 with prior lobar intracerebral hemorrhage) and 17 mutation noncarriers (M- ). Progression of PiB retention was analyzed in a subset of 18 serially imaged individuals (10 asymptomatic M+ , 8 M- ). We also analyzed associations between PiB retention and cerebrospinal fluid (CSF) Aβ concentrations in 17 M+ and 11 M- participants who underwent lumbar puncture and compared the findings to PiB-PET and CSF Aβ in 37 autosomal dominant Alzheimer disease (ADAD) mutation carriers. RESULTS D-CAA M+ showed greater age-dependent FLR PiB retention (p < 0.001) than M- , and serially imaged asymptomatic M+ demonstrated greater longitudinal increases (p = 0.004). Among M+ , greater FLR PiB retention associated with reduced CSF concentrations of Aβ40 (r = -0.55, p = 0.021) but not Aβ42 (r = 0.01, p = 0.991). Despite comparably low CSF Aβ40 and Aβ42, PiB retention was substantially less in D-CAA than ADAD (p < 0.001). INTERPRETATION Increased PiB retention in D-CAA and correlation with reduced CSF Aβ40 suggest this compound labels vascular amyloid, although to a lesser degree than amyloid deposits in ADAD. Progression in PiB signal over time suggests amyloid PET as a potential biomarker in trials of candidate agents for this untreatable cause of hemorrhagic stroke. ANN NEUROL 2019;86:616-625.
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Affiliation(s)
- Aaron P Schultz
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Reina W Kloet
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hamid R Sohrabi
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Biomedical Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Louise van der Weerd
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sanneke van Rooden
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke J H Wermer
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Laure Grand Moursel
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine and Department of Neurology (Alzheimer's Center), VU University Medical Center, Amsterdam, the Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine and Department of Neurology (Alzheimer's Center), VU University Medical Center, Amsterdam, the Netherlands
| | - Pratishtha Chatterjee
- Department of Biomedical Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Samantha L Gardener
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kevin Taddei
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Anne M Fagan
- Departments of Neurology and Radiology, Washington University School of Medicine, St Louis, MO
| | - Tammie L Benzinger
- Departments of Neurology and Radiology, Washington University School of Medicine, St Louis, MO
| | - John C Morris
- Departments of Neurology and Radiology, Washington University School of Medicine, St Louis, MO
| | - Reisa Sperling
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Keith Johnson
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Randall J Bateman
- Departments of Neurology and Radiology, Washington University School of Medicine, St Louis, MO
| | | | - M Edip Gurol
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Mark A van Buchem
- Departments of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ralph Martins
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Biomedical Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Jasmeer P Chhatwal
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
| | - Steven M Greenberg
- Departments of Neurology and Radiology, Massachusetts General Hospital, Boston, MA
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van Veluw SJ, Scherlek AA, Freeze WM, Ter Telgte A, van der Kouwe AJ, Bacskai BJ, Frosch MP, Greenberg SM. Different microvascular alterations underlie microbleeds and microinfarcts. Ann Neurol 2019; 86:279-292. [PMID: 31152566 DOI: 10.1002/ana.25512] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cerebral amyloid angiopathy (CAA) is characterized by the accumulation of amyloid β (Aβ) in the walls of cortical vessels and the accrual of microbleeds and microinfarcts over time. The relationship between CAA severity and microbleeds and microinfarcts as well as the sequence of events that lead to lesion formation remain poorly understood. METHODS We scanned intact formalin-fixed hemispheres of 12 CAA cases with magnetic resonance imaging (MRI), followed by histopathological examination in predefined areas and serial sectioning in targeted areas with multiple lesions. RESULTS In total, 1,168 cortical microbleeds and 472 cortical microinfarcts were observed on ex vivo MRI. Increasing CAA severity at the whole-brain or regional level was not associated with the number of microbleeds or microinfarcts. However, locally, the density of Aβ-positive cortical vessels was lower surrounding a microbleed compared to a simulated control lesion, and higher surrounding microinfarcts. Serial sectioning revealed that for (n = 28) microbleeds, both Aβ (4%) and smooth muscle cells (4%) were almost never present in the vessel wall at the site of bleeding, but Aβ was frequently observed upstream or downstream (71%), as was extensive fibrin(ogen) buildup (87%). In contrast, for (n = 22) microinfarcts, vascular Aβ was almost always observed at the core of the lesion (91%, p < 0.001) as well as upstream or downstream (82%), but few vessels associated with microinfarcts had intact smooth muscle cells (9%). INTERPRETATION These observations provide a model for how a single neuropathologic process such as CAA may result in hemorrhagic or ischemic brain lesions potentially through 2 different mechanistic pathways. ANN NEUROL 2019;86:279-292.
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Affiliation(s)
- Susanne J van Veluw
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ashley A Scherlek
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Whitney M Freeze
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands
| | - Annemieke Ter Telgte
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andre J van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA
| | - Brian J Bacskai
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA
| | - Matthew P Frosch
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA.,Neuropathology Service, C. S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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38
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Chen SJ, Tsai HH, Tsai LK, Tang SC, Lee BC, Liu HM, Yen RF, Jeng JS. Advances in cerebral amyloid angiopathy imaging. Ther Adv Neurol Disord 2019; 12:1756286419844113. [PMID: 31105769 PMCID: PMC6501479 DOI: 10.1177/1756286419844113] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/25/2019] [Indexed: 11/16/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease caused by β -amyloid (Aβ) deposition at the leptomeningeal vessel walls. It is a common cause of spontaneous intracerebral hemorrhage and a frequent comorbidity in Alzheimer’s disease. The high recurrent hemorrhage rate in CAA makes it very important to recognize this disease to avoid potential harmful medication. Imaging studies play an important role in diagnosis and research of CAA. Conventional computed tomography and magnetic resonance imaging (MRI) methods reveal anatomical alterations, and remains as the most reliable tool in identifying CAA according to modified Boston criteria. The vascular injuries of CAA result in both hemorrhagic and ischemic manifestations and related structural changes on MRI, including cerebral microbleeds, cortical superficial siderosis, white matter hyperintensity, MRI-visible perivascular spaces, and cortical microinfarcts. As imaging techniques advance, not only does the resolution of conventional imaging improve, but novel skills in functional and molecular imaging studies also enable in vivo analysis of vessel physiological changes and underlying pathology. These modern tools help in early detection of CAA and may potentially serve as sensitive outcome markers in future clinical trials. In this article, we reviewed past studies of CAA focusing on utilization of various conventional and novel imaging techniques in both research and clinical aspects.
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Affiliation(s)
- Szu-Ju Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, No. 87, Neijiang Street, Taipei, 10845, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bo-Chin Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Hon-Man Liu
- Department of Medical Imaging, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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Ii Y, Maeda M, Ishikawa H, Ito A, Matsuo K, Umino M, Shindo A, Kida H, Satoh M, Niwa A, Taniguchi A, Tomimoto H. Cortical microinfarcts in patients with multiple lobar microbleeds on 3 T MRI. J Neurol 2019; 266:1887-1896. [DOI: 10.1007/s00415-019-09350-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/13/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
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40
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Clinical significance of amyloid β positivity in patients with probable cerebral amyloid angiopathy markers. Eur J Nucl Med Mol Imaging 2019; 46:1287-1298. [DOI: 10.1007/s00259-019-04314-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
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41
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Tsai HH, Pasi M, Tsai LK, Chen YF, Lee BC, Tang SC, Fotiadis P, Huang CY, Yen RF, Jeng JS, Gurol ME. Microangiopathy underlying mixed-location intracerebral hemorrhages/microbleeds: A PiB-PET study. Neurology 2019; 92:e774-e781. [PMID: 30674594 PMCID: PMC6396971 DOI: 10.1212/wnl.0000000000006953] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that patients with concomitant lobar and deep intracerebral hemorrhages/microbleeds (mixed ICH) have predominantly hypertensive small vessel disease (HTN-SVD) rather than cerebral amyloid angiopathy (CAA), using in vivo amyloid imaging. METHODS Eighty Asian patients with primary ICH without dementia were included in this cross-sectional study. All patients underwent brain MRI and 11C-Pittsburgh compound B (PiB)-PET imaging. The mean cortical standardized uptake value ratio (SUVR) was calculated using cerebellum as reference. Forty-six patients (57.5%) had mixed ICH. Their demographic and clinical profile as well as amyloid deposition patterns were compared to those of 13 patients with CAA-ICH and 21 patients with strictly deep microbleeds and ICH (HTN-ICH). RESULTS Patients with mixed ICH were younger (62.8 ± 11.7 vs 73.3 ± 11.9 years in CAA, p = 0.006) and showed a higher rate of hypertension than patients with CAA-ICH (p < 0.001). Patients with mixed ICH had lower PiB SUVR than patients with CAA (1.06 [1.01-1.13] vs 1.43 [1.06-1.58], p = 0.003). In a multivariable logistic regression model, mixed ICH was associated with hypertension (odds ratio 8.9, 95% confidence interval 1.4-58.4, p = 0.02) and lower PiB SUVR (odds ratio 0.03, 95% confidence interval 0.001-0.87, p = 0.04) compared to CAA after adjustment for age. Compared to HTN-ICH, mixed ICH showed a similar mean age (62.8 ± 11.7 vs 60.1 ± 14.5 years in HTN-ICH) and risk factor profile (all p > 0.1). Furthermore, PiB SUVR did not differ between mixed ICH (values presented above) and HTN-ICH (1.10 [1.00-1.16], p = 0.45). CONCLUSIONS Patients with mixed ICH have much lower amyloid load than patients with CAA-ICH, while being similar to HTN-ICH. Overall, mixed ICH is probably caused by HTN-SVD, an important finding with clinical relevance.
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Affiliation(s)
- Hsin-Hsi Tsai
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.
| | - Marco Pasi
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Li-Kai Tsai
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.
| | - Ya-Fang Chen
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Bo-Ching Lee
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Sung-Chun Tang
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Panagiotis Fotiadis
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Chen-Yu Huang
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Ruoh-Fang Yen
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Jiann-Shing Jeng
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - M Edip Gurol
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.
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The Clinical Dilemma of Anticoagulation Use in Patients with Cerebral Amyloid Angiopathy and Atrial Fibrillation. Curr Cardiol Rep 2018; 20:106. [DOI: 10.1007/s11886-018-1052-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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43
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Weber SA, Patel RK, Lutsep HL. Cerebral amyloid angiopathy: diagnosis and potential therapies. Expert Rev Neurother 2018; 18:503-513. [DOI: 10.1080/14737175.2018.1480938] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Stewart A. Weber
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Ranish K. Patel
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Helmi L. Lutsep
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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Nobili F, Cagnin A, Calcagni ML, Chincarini A, Guerra UP, Morbelli S, Padovani A, Paghera B, Pappatà S, Parnetti L, Sestini S, Schillaci O. Emerging topics and practical aspects for an appropriate use of amyloid PET in the current Italian context. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 63:83-92. [PMID: 29697220 DOI: 10.23736/s1824-4785.18.03069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In May 2017 some representatives of the Italian nuclear medicine and neurological communities spontaneously met to discuss the issues emerged during the first two years of routine application of amyloid PET with fluorinated radiopharmaceuticals in the real world. The limitations of a binary classification of scans, the possibility to obtain early images as a surrogate marker of regional cerebral bloos flow, the need for (semi-)quantification and, thus, the opportunity of ranking brain amyloidosis, the correlation with Aβ42 levels in the cerebrospinal fluid, the occurrence and biological meaning of uncertain/boderline scans, the issue of incidental amyloidosis, the technical pittfalls leading to false negative/positive results, the position of the tool in the diagnostic flow-chart in the national reality, are the main topics that have been discussed. Also, a card to justify the examination to be filled by the dementia specialist and a card for the nuclear medicine physician to report the exam in detail have been approved and are available in the web, which should facilitate the creation of a national register, as previewed by the 2015 intersocietal recommendation on the use of amyloid PET in Italy. The content of this discussion could stimulate both public institutions and companies to support further research on these topics.
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Affiliation(s)
- Flavio Nobili
- Department of Neuroscience (DINOGMI), University of Genoa and Neurology Clinic, San Martino Polyclinic Hospital, Genoa, Italy -
| | - Annachiara Cagnin
- Department of Neurosciences (DNS), University of Padua, Padua, Italy.,San Camillo IRCCS Hospital, Venice, Italy
| | - Maria L Calcagni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Chincarini
- National Institute for Nuclear Physics (INFN), Genoa Section, Genoa, Italy
| | - Ugo P Guerra
- Unit of Nuclear Medicine, Poliambulanza Fundation, Brescia, Italy
| | - Silvia Morbelli
- Unit of Nuclear Medicine, Department of Health Sciences (DISSAL), Polyclinic San Martino Hospital, University of Genoa, Genoa, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Neurology Clinic, Spedali Civili, Brescia, Italy
| | - Barbara Paghera
- Unit of Nuclear Medicine, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Sabina Pappatà
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Lucilla Parnetti
- Center for Memory Disorders, Laboratory of Clinical Neurochemistry, Neurology Clinic, University of Perugia, Perugia, Italy
| | - Stelvio Sestini
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, N.O.P. - S. Stefano, U.S.L. Toscana Centro, Prato, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,IRCCS Neuromed, Rome, Italy
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Kim J, Na HK, Shin JH, Kim HJ, Seo SW, Seong JK, Na DL. Atrophy patterns in cerebral amyloid angiopathy with and without cortical superficial siderosis. Neurology 2018; 90:e1751-e1758. [PMID: 29678935 DOI: 10.1212/wnl.0000000000005524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/26/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate differential atrophy patterns based on the presence of cortical superficial siderosis (cSS) and the role of cSS in predicting amyloid positivity in memory clinic patients fulfilling the diagnostic criteria for probable cerebral amyloid angiopathy (CAA). METHODS We retrospectively collected data from 44 cognitively impaired patients with probable CAA who underwent 3-dimensional, T1-weighted MRIs (cSS+, n = 27; cSS-, n = 17). Amyloid-positive patients with Alzheimer disease (AD) (n = 56) and amyloid-negative cognitively normal participants (n = 34) were recruited as controls. Among the patients with CAA who underwent amyloid-PET scans (75.0%), we investigated whether amyloid-negative cases were unevenly distributed based on cSS presentation. APOE genotypes, Mini-Mental State Examination scores, and cortical atrophy pattern along with hippocampal volume were compared across groups. RESULTS Ten patients with probable CAA presented amyloid negativity and all of them belonged to the cSS- group (58.8%). Compared to the cSS- group, the cSS+ group presented higher APOE ε4 frequency, worse memory dysfunction, and lower hippocampal volume. Compared with cognitively normal participants, the cSS+ group exhibited atrophy in the precuneus, posterior cingulate, parietotemporal, superior frontal, and medial temporal areas, a pattern similar to AD-specific atrophy. The cSS- group exhibited atrophy in the parietotemporal, superior frontal, and precentral regions. CONCLUSION Our findings imply that the current version of the Boston criteria may not be sufficient enough to remove non-CAA cases from a cognitively impaired population, especially in the absence of cSS. Patients with probable CAA presenting cSS appear to reflect a CAA phenotype that shares pathologic hallmarks with AD, providing insight into the CAA-to-AD continuum.
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Affiliation(s)
- Joonho Kim
- From the Department of Neurology, Severance Hospital (H.K.N.), Yonsei University College of Medicine (J.K.), Seoul; Department of Bio-convergence Engineering (J.-H.S., J.-K.S.), and School of Biomedical Engineering (J.-K.S.), Korea University, Seoul; and Department of Neurology, Sungkyunkwan University School of Medicine (H.J.K., S.W.S., D.L.N.), and Neuroscience Center (H.J.K., S.W.S., D.L.N), Samsung Medical Center, Seoul, Republic of Korea
| | - Han Kyu Na
- From the Department of Neurology, Severance Hospital (H.K.N.), Yonsei University College of Medicine (J.K.), Seoul; Department of Bio-convergence Engineering (J.-H.S., J.-K.S.), and School of Biomedical Engineering (J.-K.S.), Korea University, Seoul; and Department of Neurology, Sungkyunkwan University School of Medicine (H.J.K., S.W.S., D.L.N.), and Neuroscience Center (H.J.K., S.W.S., D.L.N), Samsung Medical Center, Seoul, Republic of Korea
| | - Jeong-Hyeon Shin
- From the Department of Neurology, Severance Hospital (H.K.N.), Yonsei University College of Medicine (J.K.), Seoul; Department of Bio-convergence Engineering (J.-H.S., J.-K.S.), and School of Biomedical Engineering (J.-K.S.), Korea University, Seoul; and Department of Neurology, Sungkyunkwan University School of Medicine (H.J.K., S.W.S., D.L.N.), and Neuroscience Center (H.J.K., S.W.S., D.L.N), Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Jin Kim
- From the Department of Neurology, Severance Hospital (H.K.N.), Yonsei University College of Medicine (J.K.), Seoul; Department of Bio-convergence Engineering (J.-H.S., J.-K.S.), and School of Biomedical Engineering (J.-K.S.), Korea University, Seoul; and Department of Neurology, Sungkyunkwan University School of Medicine (H.J.K., S.W.S., D.L.N.), and Neuroscience Center (H.J.K., S.W.S., D.L.N), Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Won Seo
- From the Department of Neurology, Severance Hospital (H.K.N.), Yonsei University College of Medicine (J.K.), Seoul; Department of Bio-convergence Engineering (J.-H.S., J.-K.S.), and School of Biomedical Engineering (J.-K.S.), Korea University, Seoul; and Department of Neurology, Sungkyunkwan University School of Medicine (H.J.K., S.W.S., D.L.N.), and Neuroscience Center (H.J.K., S.W.S., D.L.N), Samsung Medical Center, Seoul, Republic of Korea
| | - Joon-Kyung Seong
- From the Department of Neurology, Severance Hospital (H.K.N.), Yonsei University College of Medicine (J.K.), Seoul; Department of Bio-convergence Engineering (J.-H.S., J.-K.S.), and School of Biomedical Engineering (J.-K.S.), Korea University, Seoul; and Department of Neurology, Sungkyunkwan University School of Medicine (H.J.K., S.W.S., D.L.N.), and Neuroscience Center (H.J.K., S.W.S., D.L.N), Samsung Medical Center, Seoul, Republic of Korea.
| | - Duk L Na
- From the Department of Neurology, Severance Hospital (H.K.N.), Yonsei University College of Medicine (J.K.), Seoul; Department of Bio-convergence Engineering (J.-H.S., J.-K.S.), and School of Biomedical Engineering (J.-K.S.), Korea University, Seoul; and Department of Neurology, Sungkyunkwan University School of Medicine (H.J.K., S.W.S., D.L.N.), and Neuroscience Center (H.J.K., S.W.S., D.L.N), Samsung Medical Center, Seoul, Republic of Korea.
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Greenberg SM, Charidimou A. Diagnosis of Cerebral Amyloid Angiopathy: Evolution of the Boston Criteria. Stroke 2018; 49:491-497. [PMID: 29335334 PMCID: PMC5892842 DOI: 10.1161/strokeaha.117.016990] [Citation(s) in RCA: 273] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Steven M Greenberg
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Boston.
| | - Andreas Charidimou
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Boston
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Raposo N, Sonnen JA. Amyloid-PET in cerebral amyloid angiopathy: Detecting vascular amyloid deposits, not just blood. Neurology 2017; 89:1437-1438. [PMID: 28855405 DOI: 10.1212/wnl.0000000000004548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicolas Raposo
- From the Neurology Department (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Department of Pathology (J.A.S.), University of Utah, Salt Lake City.
| | - Joshua A Sonnen
- From the Neurology Department (N.R.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; Toulouse NeuroImaging Center (N.R.), Université de Toulouse, Inserm, UPS, France; and Department of Pathology (J.A.S.), University of Utah, Salt Lake City
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