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White matter perivascular spaces: an MRI marker in pathology-proven cerebral amyloid angiopathy?
Andreas Charidimou1, Zane Jaunmuktane, Jean-Claude Baron
1From the Stroke Research Group (A.C., D.J.W.), Division of Neuropathology and Department of Neurodegenerative Disease (Z.J., S.B.), and Lysholm Department of Neuroradiology (R.J.), UCL Institute of Neurology, London, UK; The National Hospital for Neurology and Neurosurgery (A.C., R.J., D.J.W.), London, UK; Department of Clinical Neurosciences (J.-C.B.) and Department of Pathology (J.X.), University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Department of Neuropathology (J.-C.B., P.V.), Hospital Sainte-Anne, Paris, France; University Paris Descartes (J.-C.B., P.V.), Paris, France; Biomedical Research Centre (M.B.), UCL, UK; and Department of Neurology (A.P.), Cliniques Universitaires UCL Saint Luc, Brussels, Belgium.
Objective:
We investigated whether severe, MRI-visible perivascular spaces (PVS) in the cerebral hemisphere white matter (centrum semiovale) are more common in patients with pathology-proven cerebral amyloid angiopathy (CAA) than in those with pathology-proven non-CAA-related intracerebral hemorrhage (ICH).
Methods:
Using a validated 4-point scale on axial T2-weighted MRI, we compared PVS in patients with pathology-proven CAA to PVS in those with spontaneous ICH but no histopathologic evidence of CAA. In a preliminary analysis restricted to patients with T2*-weighted gradient-recalled echo MRI, we also investigated whether including severe centrum semiovale PVS increases the sensitivity of existing diagnostic criteria for probable CAA.
Results:
Fourteen patients with CAA and 10 patients with non-CAA-related ICH were included. Eight of the patients with CAA were admitted for symptomatic, spontaneous lobar ICH, 1 because of ischemic stroke, 1 with transient focal neurologic episodes, and 4 due to cognitive decline. Severe (>20) centrum semiovale PVS were more frequent in patients with CAA compared to controls (12/14 [85.7%; 95% confidence interval (CI): 57.2%-98.2%] vs 0/10 [1-sided 95% CI: 0%-30.8%], p < 0.0005); this was robust to adjustment for age. The original Boston criteria for probable CAA showed a sensitivity of 76.9% (95% CI: 46.2%-95%), which increased to 92.3% (95% CI: 64%-99.8%), without loss of specificity, after including severe centrum semiovale PVS.
Conclusions:
Severe centrum semiovale PVS on MRI may be a promising new neuroimaging marker for the in vivo diagnosis of CAA. However, our findings are preliminary and require confirmation and external validation in larger cohorts of pathology-proven CAA.
Insights
Severe perivascular spaces (PVS) in the centrum semiovale on MRI are more common in cerebral amyloid angiopathy (CAA) patients. This finding may improve in vivo diagnosis of CAA, but requires further validation.
Area of Science:
- Neurology
- Neuroimaging
- Pathology
Background:
- Cerebral amyloid angiopathy (CAA) is a significant cause of intracerebral hemorrhage (ICH).
- Accurate in vivo diagnosis of CAA remains challenging.
- Perivascular spaces (PVS) are fluid-filled spaces surrounding blood vessels in the brain.
Purpose of the Study:
- To investigate the association between severe centrum semiovale PVS and pathology-proven cerebral amyloid angiopathy (CAA).
- To evaluate if including severe centrum semiovale PVS improves diagnostic criteria for probable CAA.
Main Methods:
- Retrospective comparison of severe PVS (using a 4-point scale on T2-weighted MRI) in patients with pathology-proven CAA versus non-CAA ICH.
- Analysis of T2*-weighted MRI data to assess the impact of severe centrum semiovale PVS on diagnostic sensitivity for probable CAA.
Main Results:
- Severe centrum semiovale PVS were significantly more frequent in patients with CAA (85.7%) compared to controls (0%) (p < 0.0005).
- The inclusion of severe centrum semiovale PVS increased the sensitivity of the Boston criteria for probable CAA from 76.9% to 92.3% without affecting specificity.
Conclusions:
- Severe centrum semiovale PVS identified on MRI may serve as a novel neuroimaging biomarker for in vivo CAA diagnosis.
- These preliminary findings require confirmation and validation in larger, independent cohorts.
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