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Microangiopathy underlying mixed-location intracerebral hemorrhages/microbleeds: A PiB-PET study

Hsin-Hsi Tsai1, Marco Pasi2, Li-Kai Tsai1

  • 1From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei. edip@mail.harvard.edu milikai@ntuh.gov.tw.

Neurology
|January 25, 2019
PubMed
Abstract

Insights

Mixed intracerebral hemorrhages (ICH) show lower amyloid deposition than cerebral amyloid angiopathy (CAA). This suggests mixed ICH is primarily caused by hypertensive small vessel disease (HTN-SVD), not CAA.

Area of Science:

  • Neurology
  • Neuroimaging
  • Cerebrovascular Diseases

Background:

  • Intracerebral hemorrhage (ICH) can stem from hypertensive small vessel disease (HTN-SVD) or cerebral amyloid angiopathy (CAA).
  • Distinguishing the underlying cause of mixed ICH (lobar and deep hemorrhages/microbleeds) is crucial for understanding disease mechanisms and treatment.

Purpose of the Study:

  • To investigate whether patients with mixed ICH exhibit predominantly HTN-SVD or CAA.
  • To differentiate the etiology of mixed ICH using in vivo amyloid imaging (11C-Pittsburgh compound B or PiB-PET).

Main Methods:

  • Cross-sectional study of 80 Asian patients with primary ICH without dementia.
  • Brain MRI and 11C-Pittsburgh compound B (PiB)-PET imaging were performed.
  • Amyloid deposition was quantified using PiB-PET SUVR and compared between mixed ICH, CAA-ICH, and HTN-ICH groups.

Main Results:

  • Mixed ICH patients were younger and had higher rates of hypertension compared to CAA-ICH patients.
  • Mixed ICH showed significantly lower PiB SUVR than CAA-ICH, indicating less amyloid deposition.
  • Mixed ICH had similar age, risk factor profiles, and PiB SUVR to HTN-ICH, suggesting a shared etiology.

Conclusions:

  • Mixed ICH demonstrates substantially lower amyloid load compared to CAA-ICH.
  • The findings support that mixed ICH is predominantly caused by HTN-SVD rather than CAA.
  • This distinction has significant clinical implications for managing patients with intracerebral hemorrhage.

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