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Schwarz G, Banerjee G, Hostettler IC, Ambler G, Seiffge DJ, Ozkan H, Browning S, Simister R, Wilson D, Cohen H, Yousry T, Al-Shahi Salman R, Lip GYH, Brown MM, Muir KW, Houlden H, Jäger R, Werring DJ. MRI and CT imaging biomarkers of cerebral amyloid angiopathy in lobar intracerebral hemorrhage. Int J Stroke 2023; 18:85-94. [PMID: 34994246 DOI: 10.1177/17474930211062478] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA), a common cause of intracerebral hemorrhage (ICH), is diagnosed using the Boston criteria including magnetic resonance imaging (MRI) biomarkers (cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS). The simplified Edinburgh criteria include computed tomography (CT) biomarkers (subarachnoid extension (SAE) and finger-like projections (FLPs)). The underlying mechanisms and diagnostic accuracy of CT compared to MRI biomarkers of CAA are unknown. METHODS We included 140 survivors of spontaneous lobar supratentorial ICH with both acute CT and MRI. We assessed associations between MRI and CT biomarkers and the diagnostic accuracy of CT- compared to MRI-based criteria. RESULTS FLPs were more common in patients with strictly lobar CMB (44.7% vs 23.5%; p = 0.014) and SAE was more common in patients with cSS (61.3% vs 31.2%; p = 0.002). The high probability of the CAA category of the simplified Edinburgh criteria showed 87.2% (95% confidence interval (CI): 78.3-93.4) specificity, 29.6% (95% CI: 18.0-43.6) sensitivity, 59.3% (95% CI: 38.8-77.6) positive predictive value, and 66.4% (95%: CI 56.9-75.0) negative predictive value, 2.3 (95% CI: 1.2-4.6) positive likelihood ratio and 0.8 (95% CI 0.7-1.0) negative likelihood ratio for probable CAA (vs non-probable CAA), defined by the modified Boston criteria; the area under the receiver operating characteristic curve (AUROC) was 0.62 (95% CI: 0.54-0.71). CONCLUSION In lobar ICH survivors, we found associations between putative biomarkers of parenchymal CAA (FLP and strictly lobar CMBs) and putative biomarkers of leptomeningeal CAA (SAE and cSS). In a hospital population, CT biomarkers might help rule-in probable CAA (diagnosed using the Boston criteria), but their absence is probably not as useful to rule it out, suggesting an important continued role for MRI in ICH survivors with suspected CAA.
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Affiliation(s)
- Ghil Schwarz
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
- Department of Neurology and Stroke Unit ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gargi Banerjee
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
| | - Isabel C Hostettler
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - David J Seiffge
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
- Department of Neurology and Stroke Center, Inselspital, Bern, Switzerland
| | - Hatice Ozkan
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
| | - Simone Browning
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
| | - Robert Simister
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
| | - Duncan Wilson
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Tarek Yousry
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martin M Brown
- Stroke Research Centre, Institute of Neurology, University College London, London, UK
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow and Queen Elizabeth University Hospital, Glasgow, UK
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - David J Werring
- Stroke Research Centre, Institute of Neurology, UCL Queen Square Institute of Neurology and National Hospital of Neurology and Neurosurgery, London, UK
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