MRI and CT imaging biomarkers of cerebral amyloid angiopathy in lobar intracerebral hemorrhage

Schwarz, G. et al. (2023) MRI and CT imaging biomarkers of cerebral amyloid angiopathy in lobar intracerebral hemorrhage. International Journal of Stroke, 18(1), pp. 85-94. (doi: 10.1177/17474930211062478) (PMID:34994246)

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.

• Item Type: Articles
• Additional Information: Funding: G.B. holds an NIHR Academic Clinical Fellowship and has received funding from the Rosetrees Trust. D.J.W. receives funding from the Stroke Foundation and British Heart Foundation. R.S. receives funding from UCLH/UCL BRC. H.H. and I.C.H. received funding from the Alzheimer Research UK and Dunhill Medical Trust Foundation. This work was undertaken at UCLH/ UCL, which receives a proportion of funding from the Department of Health’s National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Muir, Professor Keith
• Authors: Schwarz, G., Banerjee, G., Hostettler, I. C., Ambler, G., Seiffge, D. J., Ozkan, H., Browning, S., Simister, R., Wilson, D., Cohen, H., Yousry, T., Salman, R. A.-S., Lip, G. Y. H., Brown, M. M., Muir, K. W., Houlden, H., Jäger, R., and Werring, D. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: International Journal of Stroke
• Publisher: SAGE Publications
• ISSN: 1747-4930
• ISSN (Online): 1747-4949
• Published Online: 07 January 2022
• Copyright Holders: Copyright © 2022 World Stroke Organization
• First Published: First published in International Journal of Stroke 2022
• Publisher Policy: Reproduced in accordance with the publisher copyright policy