Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy
Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy
复制标题
DOI：
10.1212/01.wnl.0000345666.83318.03
复制
发表时间：
2009-04-07
期刊：
影响因子：
9.9
通讯作者：
Greenberg, S. M.
中科院分区：
文献类型：
--
作者：
Kimberly, W. T.;Gilson, A.;Greenberg, S. M.
背景：神经病理学研究表明，脑淀粉样血管病（CAA）与小范围缺血性梗死和出血之间存在关联。我们检查了弥散加权成像（DWI）检测梗死的患病率和相关危险因素。方法：我们对78名诊断为可能CAA的受试者和55名类似年龄组的阿尔茨海默病或轻度认知障碍（AD/MCI）受试者的MR图像进行回顾性分析，以进行比较。检查DWI和表观扩散系数（ADC）图是否有急性或亚急性梗死。我们还研究了DWI病变与人口统计学变量、常规血管危险因素和CAA严重程度的放射学标志物（如梯度回声MRI上的出血数量和t2高白质病变的体积）之间的关系。结果：78例CAA患者中有12例（15%）共出现17例符合亚急性脑梗死的dwi高强度病变，而55例AD/MCI患者中0例（p = 0.001）。DWI病变主要位于皮层和皮层下白质。有DWI病变的CAA患者总出血中位数较高（22 vs 4, p = 0.025），与无病变的CAA患者相比，白质高强度体积或常规血管危险因素无差异。结论：MRI证据表明，在相当比例的晚期脑淀粉样血管病（CAA）患者中存在小的亚急性梗死。这些病变的存在与较高的出血负担有关，但与传统的血管危险因素无关。这表明晚期CAA易发生缺血性梗死和脑出血。神经病学(R) 2009;72: 1230 - 1235
Background: Neuropathologic studies suggest an association between cerebral amyloid angiopathy (CAA) and small ischemic infarctions as well as hemorrhages. We examined the prevalence and associated risk factors for infarcts detected by diffusion-weighted imaging (DWI).Methods: We performed retrospective analysis of MR images from 78 subjects with a diagnosis of probable CAA and a similar aged group of 55 subjects with Alzheimer disease or mild cognitive impairment (AD/MCI) for comparison. DWI and apparent diffusion coefficient (ADC) maps were inspected for acute or subacute infarcts. We also examined the association between DWI lesions and demographic variables, conventional vascular risk factors, and radiographic markers of CAA severity such as number of hemorrhages on gradient-echo MRI and volume of T2-hyperintense white matter lesions.Results: Twelve of 78 subjects with CAA (15%) had a total of 17 DWI-hyperintense lesions consistent with subacute cerebral infarctions vs 0 of 55 subjects with AD/MCI (p = 0.001). The DWI lesions were located primarily in cortex and subcortical white matter. CAA subjects with DWI lesions had a higher median number of total hemorrhages ( 22 vs 4, p = 0.025) and no difference in white matter hyperintensity volume or conventional vascular risk factors compared to subjects with CAA without lesions.Conclusions: MRI evidence of small subacute infarcts is present in a substantial proportion of living patients with advanced cerebral amyloid angiopathy ( CAA). The presence of these lesions is associated with a higher burden of hemorrhages, but not with conventional vascular risk factors. This suggests that advanced CAA predisposes to ischemic infarction as well as intracerebral hemorrhage. Neurology(R) 2009; 72: 1230-1235