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Published on: November 20, 2015
Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage
Sergi Martinez-Ramirez1, Jose-Rafael Romero2, Ashkan Shoamanesh3
1Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA; Escola de Postgrau, Autonomous University of Barcelona, Barcelona, Spain.
Introduction:
The Boston criteria are the basis for a noninvasive diagnosis of cerebral amyloid angiopathy (CAA) in the setting of lobar intracerebral hemorrhage (ICH). We assessed the accuracy of these criteria in individuals with lobar microbleeds (MBs) without ICH.
Methods:
We identified individuals aged >55 years having brain magnetic resonance imaging (MRI) and pathological assessment of CAA in a single academic hospital and a community-based population (Framingham Heart Study [FHS]). We determined the positive predictive value (PPV) of the Boston criteria for CAA in both cohorts, using lobar MBs as the only hemorrhagic lesion to fulfill the criteria.
Results:
We included 102 individuals: 55 from the hospital-based cohort and 47 from FHS (mean age at MRI 74.7 ± 8.5 and 83.4 ± 10.9 years; CAA prevalence 60% and 46.8%; cases with any lobar MB 49% and 21.3%; and cases with ≥2 strictly lobar MBs 29.1% and 8.5%, respectively). PPV of "probable CAA" (≥2 strictly lobar MBs) was 87.5% (95% confidence interval [CI], 60.4-97.8) and 25% (95% CI, 13.2-78) in hospital and general populations, respectively.
Discussion:
Strictly lobar MBs strongly predict CAA in non-ICH individuals when found in a hospital context. However, their diagnostic accuracy in the general population appears limited.
Insights
The Boston criteria accurately identify cerebral amyloid angiopathy (CAA) in hospital patients with lobar microbleeds (MBs). However, their diagnostic value is limited in the general population without intracerebral hemorrhage (ICH).
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- The Boston criteria are foundational for diagnosing cerebral amyloid angiopathy (CAA) noninvasively, particularly in cases of lobar intracerebral hemorrhage (ICH).
- This study evaluates the diagnostic accuracy of the Boston criteria in individuals presenting with lobar microbleeds (MBs) but without a history of ICH.
Purpose of the Study:
- To assess the positive predictive value (PPV) of the Boston criteria for diagnosing CAA in patients with lobar microbleeds but no ICH.
- To compare the diagnostic accuracy of the Boston criteria in a hospital-based cohort versus a general population cohort.
Main Methods:
- Retrospective analysis of 102 individuals over 55 years old who underwent brain MRI and pathological assessment for CAA.
- Inclusion of patients from both an academic hospital and the Framingham Heart Study (FHS) general population cohort.
- Utilizing strictly lobar microbleeds as the sole criterion for probable CAA diagnosis.
Main Results:
- In the hospital cohort (n=55), the PPV of probable CAA (≥2 strictly lobar MBs) was 87.5%.
- In the Framingham Heart Study cohort (n=47), the PPV of probable CAA was significantly lower at 25%.
- CAA prevalence was 60% in the hospital cohort and 46.8% in the FHS cohort.
Conclusions:
- Strictly lobar microbleeds are strong predictors of CAA in non-ICH individuals within a hospital setting.
- The diagnostic accuracy of the Boston criteria, using lobar microbleeds, is limited in the general population.
- Further research may be needed to refine diagnostic criteria for CAA in community-based populations.
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