大脑粉样性血管病变:临床表现,后续和神经影像特征 - 一个更新
Stefan Weidauer1, Elke Hattingen1
1Institute of Neuroradiology, Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany.
Biomedicines
|March 28, 2025
概括
大脑粉样血管病变 (CAA) 随着年龄的增长而增加,经常导致大脑内出血和认知能力下降. 诊断依赖于MRI和临床发现,活检证实了罕见的炎症变体.
科学领域:
- 神经学 神经学
- 神经辐射学神经辐射学
- 病理学 病理学 病理学
背景情况:
- 大脑粉样血管病变 (CAA) 的患病率随着年龄的增长而上升,影响超过50%的80岁以上认知障碍患者.
- CAA通常表现为分叶脑内出血 (ICH),重复的神经发作和认知衰退,可能会发展为阿尔茨海默病 (AD).
- 神经辐射的症状包括微型血流,下关节出血,表面性 siderosis 和非出血变化,如扩张的周脉空间和MRI上的T2超强度.
研究的目的:
- 提供关于脑粉样血管病变 (CAA) 和其临床后果的简短更新.
- 审查自发CAA和自身抗体相关的CAA相关炎症 (CAA-ri) 的诊断标准和成像发现.
- 讨论在粉样抗体治疗期间观察到的粉样蛋白相关成像异常 (ARIA) 的管理策略.
主要方法:
- 关于大脑粉样血管病变 (CAA) 的当前文献的综述.
- 对神经放射学发现的分析,包括自发CAA和CAA相关炎症 (CAA-ri) 的MRI特征.
- 评估诊断标准,如波士顿标准2.0,以及活检的作用.
主要成果:
- 波士顿标准2.0,结合非出血性MRI发现,提高CAA诊断的敏感性和特异性.
- 与自身抗体相关的CAA相关的炎症 (CAA-ri) 与MRI发现类似于ARIA,包括血管性胀 (ARIA-E) 和出血性病变 (ARIA-H).
- 大约20%的接受ARIA单克隆抗体治疗的患者在MRI上出现临床症状;轻度ARIA病例可能需要继续治疗和监测.
结论:
- 组织学确认仍然是确定CAA诊断的黄金标准.
- 临床和MRI发现有助于诊断可能或可能的CAA-ri,活检是最终的方法.
- 在接受粉样蛋白向治疗的患者中,对ARIA的管理需要仔细监测,在轻度病例中通常建议继续治疗.
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