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Posterior white matter disease distribution as a predictor of amyloid angiopathy

Sekh Thanprasertsuk1, Sergi Martinez-Ramirez1, Octavio Marques Pontes-Neto1

  • 1From the J. Philip Kistler Stroke Research Center (S.T., S.M.-R., O.M.P.-N., J.N., A.A., A.R., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Boston; Faculty of Medicine (S.T.), Chulalongkorn University, Bangkok, Thailand; and Escola de Postgrau (S.M.-R.), Universitat Autònoma de Barcelona, Edicifi U, Campus UAB, Bellaterra (Cerdanyola del Vallès), Spain.

Neurology
|July 27, 2014
PubMed
Abstract

Insights

Posterior white matter hyperintensities (WMH) distribution predicts cerebral amyloid angiopathy (CAA) pathology, even without lobar hemorrhages. This finding suggests WMH distribution is a novel MRI marker for CAA.

Area of Science:

  • Neurology
  • Neuroradiology
  • Pathology

Background:

  • Cerebral amyloid angiopathy (CAA) is a significant cause of spontaneous lobar intracerebral hemorrhage and microbleeds.
  • White matter hyperintensities (WMH) are common in aging brains and associated with various neurological conditions.
  • The anteroposterior (AP) distribution of WMH has not been extensively studied as a potential marker for CAA.

Purpose of the Study:

  • To investigate if posterior WMH distribution is an independent predictor of pathologically confirmed CAA.
  • To determine if WMH distribution correlates with MRI markers of CAA, such as microbleeds (MBs) and dilated perivascular spaces (DPVS).
  • To assess these associations in patients without a history of lobar intracerebral hemorrhage.

Main Methods:

  • Developed a quantitative method to measure the AP distribution of WMH on MRI.
  • Retrospectively analyzed a cohort of patients with pathological CAA evaluation (n=59) to assess WMH as a predictor.
  • Examined the association of WMH distribution with lobar MBs (n=259) and DPVS (n=85) in a separate memory clinic cohort.

Main Results:

  • Posterior WMH distribution was an independent predictor of pathological CAA (OR=1.19, p=0.001), including in patients without lobar MBs.
  • Strictly lobar MBs were independently associated with a more posterior WMH distribution (p=0.009).
  • AP WMH distribution correlated with DPVS location, with posterior WMH associated with DPVS in the white matter over basal ganglia (p=0.001).

Conclusions:

  • The anteroposterior distribution of WMH on MRI may serve as an additional imaging biomarker for cerebral amyloid angiopathy.
  • This association holds true even in the absence of lobar hemorrhages, expanding its potential clinical utility.
  • WMH distribution offers a non-invasive marker that may aid in the diagnosis and understanding of CAA.

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