The Evaluation of Quantitative MRA for Cerebral Amyloid Angiopathy with Vascular Risk Factors
Mohamad H Mosi1, Dan Cheng2, Mona Kharaji1
1From the Department of Radiology (M.H.M., M.K., C.W., G.C., A.A.S., C.S.-V., N.B., M.M.-B.), University of Washington School of Medicine, Seattle, Washington.
Insights
Quantitative MRA total arterial length is significantly reduced in patients with Cerebral Amyloid Angiopathy (CAA). This finding suggests arterial length may serve as a novel imaging biomarker for diagnosing CAA.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Cerebral Amyloid Angiopathy (CAA) is a primary cause of intracranial hemorrhage and cognitive decline in the elderly.
- Identifying reliable biomarkers for CAA is crucial for early diagnosis and management.
- Current diagnostic methods may not fully capture the vascular pathology associated with CAA.
Purpose of the Study:
- To investigate quantitative Magnetic Resonance Angiography (MRA) features as potential novel biomarkers for Cerebral Amyloid Angiopathy (CAA).
- To assess the association between quantitative MRA metrics and the presence of CAA.
- To explore the utility of MRA in understanding vascular segment involvement in CAA.
Main Methods:
- A cross-sectional study including patients with CAA and controls who underwent 3D Time-of-flight MRA (TOF-MRA).
- Quantitative MRA features, including total arterial length, number of branches, and tortuosity, were extracted using semi-automated software.
- Demographic, clinical, and radiologic data were collected and analyzed using univariable and multivariable logistic regression.
Main Results:
- Patients with CAA exhibited significantly reduced total arterial length compared to controls (1900±1240 mm vs. 2880±1540 mm, p=0.006).
- Multivariable analysis revealed that total arterial length (OR = 0.95; 95% CI: 0.92-0.99; p=0.014) and age remained independently associated with CAA diagnosis.
- Total arterial length emerged as a significant predictor of CAA in both univariable and multivariable analyses.
Conclusions:
- Quantitative MRA total arterial length is inversely and independently associated with CAA diagnosis.
- Reduced total arterial length may serve as a valuable imaging marker for CAA.
- This quantitative MRA approach could enhance the understanding of vascular alterations in CAA.
Background And Purpose:
Cerebral amyloid angiopathy (CAA) is a leading cause of intracranial hemorrhage and cognitive decline in the elderly. This study seeks to investigate the quantitative MRA features as new markers of CAA.
Materials And Methods:
In this cross-sectional study, consecutive patients with CAA and controls who underwent 3D time-of-flight MRA were included. Demographic and clinical data, including sex, age, diabetes, smoking, hypertension, and atrial fibrillation, were collected. Radiologic features, including the microhemorrhage classification, siderosis, and Fazekas scale, were also collected. Using in-house developed semiautomated software (VesselVoyager), quantitative MRA features, including total arterial length, number of branches, and tortuosity, were extracted. Univariable and multivariable logistic regression analyses were then performed to compare the CAA and non-CAA cohorts.
Results:
Seventy-four patients were included: 43 with CAA and 31 controls. Quantitative MRA analysis showed that patients with CAA had significantly reduced total arterial length (1900 ± 1240 mm versus 2880 ± 1540 mm; P = .006). Univariable logistic regression identified total arterial length (P = .009), age (P = .012), and total branch number (P = .107) as relevant predictors of CAA. In multivariable analysis, total arterial length (OR: 0.95; 95% CI: 0.92-0.99; P = .014) and age (OR: 1.06; 95% CI: 1.01-1.12; P = .023) remained independently associated with CAA diagnosis.
Conclusions:
Quantitative MRA total arterial length is inversely, independently, and significantly associated with CAA diagnosis. This could potentially serve as an imaging marker of CAA diagnosis and potentially further elucidate vascular segment involvement in patients with CAA.
