Diagnostic Accuracy of Posterior/Anterior Periventricular WMH Ratio to Differentiate CAA From Hypertensive Arteriopathy

Louise Deasy ¹, Sabine Laurent-Chabalier ², Anne Wacongne ¹

⁰Department of Neurology (L.D., A.W., T.P., E.T., D.R.), CHU Nîmes, Université de Montpellier, France.

Stroke +

|

June 26, 2024

View abstract on PubMed

Summary

Periventricular white matter hyperintensities (PVWMH) show a posterior predominance in cerebral amyloid angiopathy (CAA) compared to hypertensive arteriopathy. This posterior distribution and extent of PVWMH can aid in diagnosing probable CAA.

Area Of Science

Neurology
Radiology
Neuroimaging

Background

Periventricular white matter hyperintensities (PVWMH) in cerebral amyloid angiopathy (CAA) have been suggested to be posterior predominant.
Previous studies utilized semiautomated segmentation and logarithmic transformation for PVWMH analysis.
This study aimed to compare PVWMH extent and distribution using readily available radiological tools.

Purpose Of The Study

To compare the extent and posterior/anterior distribution of PVWMH between patients with CAA and those with hypertensive arteriopathy.
To evaluate the utility of radiological tools in differentiating these conditions based on PVWMH patterns.
To develop a predictive model for CAA using PVWMH characteristics.

Main Methods

Retrospective analysis of axial FLAIR images from 108 patients with CAA and 99 with hypertensive arteriopathy.
Measurement of maximal PVWMH distance from the lateral ventricle borders in anterior and posterior horns.
Calculation of anterior, posterior, and total PVWMH extent, along with posterior/anterior ratios.

Main Results

Patients with CAA were older, less frequently male, and had less hypertension than those with hypertensive arteriopathy.
CAA showed significantly more extensive posterior PVWMH and higher posterior/anterior ratios compared to hypertensive arteriopathy.
A predictive model incorporating total PVWMH extent and posterior/anterior ratio demonstrated good diagnostic performance for CAA (AUC 0.76).

Conclusions

Severe posterior PVWMH and a high posterior/anterior PVWMH ratio are associated with probable CAA.
Radiological tools commonly used in clinical practice can effectively assess PVWMH patterns for CAA diagnosis.
The findings suggest that PVWMH distribution is a valuable imaging biomarker for differentiating CAA from hypertensive arteriopathy.

Keywords:

cerebral amyloid angiopathy cerebral hemorrhage cognitive dysfunction stroke subarachnoid hemorrhage