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Cerebral amyloid angiopathy burden associated with leukoaraiosis: a positron emission tomography/magnetic resonance

M Edip Gurol1, Anand Viswanathan, Christopher Gidicsin

  • 1Hemorrhagic Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA.

Annals of Neurology
|February 21, 2013
PubMed
Abstract

Insights

Vascular amyloid burden, measured by Pittsburgh compound B (PiB) PET, correlates with white matter hyperintensities (WMH) in cerebral amyloid angiopathy (CAA) patients. This suggests amyloid contributes to chronic brain ischemia in CAA but not Alzheimer disease.

Area of Science:

  • Neurology
  • Neuroimaging
  • Amyloidosis

Background:

  • Chronic brain ischemia, indicated by white matter hyperintensities (WMH), is a significant neurological concern.
  • Amyloid deposition is implicated in various neurological conditions, including cerebral amyloid angiopathy (CAA) and Alzheimer disease (AD).
  • The relationship between amyloid burden and WMH requires further elucidation, particularly differentiating between vascular and parenchymal amyloidosis.

Purpose of the Study:

  • To investigate the correlation between amyloid burden, measured by Pittsburgh compound B (PiB) positron emission tomography (PET), and the extent of WMH on magnetic resonance imaging (MRI).
  • To determine if this correlation differs between patients with predominant vascular amyloid (CAA) and those with predominant parenchymal amyloid (AD/MCI), as well as healthy elderly (HE) individuals.

Main Methods:

  • A cohort of 42 nondemented CAA patients, 50 HE subjects, and 43 AD/MCI patients underwent brain MRI and PiB PET.
  • Multivariate linear regression analysis was employed to assess the independent association between PiB retention and WMH volume.
  • Analyses controlled for age, gender, apolipoprotein E genotype, and vascular risk factors.

Main Results:

  • CAA patients exhibited significantly higher WMH volumes compared to HE and AD/MCI groups, despite being younger.
  • A strong positive correlation was observed between global PiB retention and WMH volume in the CAA group (rho = 0.52, p < 0.001).
  • This correlation was not significant in the HE or AD/MCI groups, and lobar microbleed count independently predicted WMH volume in CAA patients.

Conclusions:

  • Amyloid burden independently correlates with WMH volume in CAA patients, suggesting vascular amyloid directly contributes to chronic cerebral ischemia.
  • The findings support the hypothesis that vascular amyloid, not parenchymal amyloid, is associated with WMH in this context.
  • Amyloid imaging may serve as a valuable marker for assessing CAA severity and its impact on brain health.

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