Total Magnetic Resonance Imaging Burden of Small Vessel Disease in Cerebral Amyloid Angiopathy: An Imaging-Pathologic Study of Concept Validation.
Total Magnetic Resonance Imaging Burden of Small Vessel Disease in Cerebral Amyloid Angiopathy: An Imaging-Pathologic Study of Concept Validation.
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DOI：
10.1001/jamaneurol.2016.0832
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发表时间：
2016-08-01
期刊：
影响因子：
29
通讯作者：
Viswanathan A
中科院分区：
文献类型：
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作者：
Charidimou A;Martinez-Ramirez S;Reijmer YD;Oliveira-Filho J;Lauer A;Roongpiboonsopit D;Frosch M;Vashkevich A;Ayres A;Rosand J;Gurol ME;Greenberg SM;Viswanathan A
脑淀粉样血管病（CAA）特征性地与小血管脑损伤的MRI生物标志物相关，包括严格意义上的大叶性脑微出血、皮质浅表性铁沉着、半瓣膜体血管周围间隙和白质高信号。尽管这些神经成像标志物反映了CAA中不同的病理生理方面，但迄今为止还没有研究将这些结构成像特征结合起来衡量CAA中脑小血管疾病的总负担。基于该疾病最显著的成像特征，开发一种复合评分方法，以捕获CAA患者小血管疾病的总脑MRI负担。此外，探讨该评分是否提供CAA严重程度的独立和补充信息，CAA严重程度定义为生命中脑出血（ICH）或出血相关的神经病理改变。MRI-pathological研究。基于1997-2012年马萨诸塞州总医院（MGH）合格患者的单中心神经病理CAA队列研究。有CAA病理证据的患者（即常规采集的脑活检、血肿清除或尸检活检中是否存在CAA）和可用的足够质量的脑MRI序列，包括T2加权、T2*加权梯度回忆回声（T2*-GRE）和/或SWI和FLAIR序列。脑mri对脑小叶性出血、皮质浅表性铁沉着、半瓣膜体周围血管间隙和白质高信号进行评分。所有四个MRI病变被纳入预先指定的顺序总小血管疾病评分，评分范围为0-6分。采用逻辑回归和有序回归方法探讨与caa相关的血管病变（纤维蛋白样坏死和壁同心裂）严重程度、临床表现、ICH数量和其他未纳入评分的影像学指标的关系。在多变量有序回归分析中，CAA相关血管病变的严重程度（OR: 2.40; 95%CI: 1.06-5.45; p=0.035）和CAA表现为症状性脑出血（OR: 2.23; 95%CI: 1.07-4.64; p=0.033）与MRI小血管疾病总评分独立相关。在校正分析中，该评分与小的急性弥散加权成像病变和后脑白质高信号有关。我们的研究为CAA的MRI小血管疾病总评分的概念有效性提供了证据。在进一步验证后，这种方法有可能用于前瞻性临床研究。
Cerebral amyloid angiopathy (CAA) is characteristically associated with MRI biomarkers of small vessel brain injury, including strictly lobar cerebral microbleeds, cortical superficial siderosis, centrum semiovale perivascular spaces, and white matter hyperintensities. Although these neuroimaging markers reflect distinct pathophysiological aspects in CAA, no studies to date have combined these structural imaging features to gauge total brain small vessel disease burden in CAA. To develop a composite score to capture the total brain MRI burden of small vessel disease in CAA, based on the most salient imaging signatures of the disease. Furthermore, to explore whether this score contributes independent and complementary information about CAA severity, defined as intracerebral hemorrhage (ICH) during life or bleeding-related neuropathologic changes. MRI-pathological study. Single centre neuropathological CAA cohort based on eligible patients from the Massachusetts General Hospital (MGH) (1997–2012). Patients with both pathological evidence of CAA (i.e. any presence of CAA from routinely collected brain biopsy, biopsy at hematoma evacuation or autopsy) and available brain MRI sequences of adequate quality including T2-weighted, T2*-weighted gradient-recalled echo (T2*-GRE) and/or SWI and FLAIR sequences. Brain MRIs were rated for lobar cerebral microbleeds, cortical superficial siderosis, centrum semiovale perivascular spaces and white matter hyperintensities. All four MRI lesions were incorporated into a pre-specified ordinal total small vessel disease score ranging from 0–6 points. Associations with severity of CAA-associated vasculopathic changes (fibrinoid necrosis and concentric splitting of the wall), clinical presentation, ICH number and other imaging markers not included in the score were explored using logistic and ordinal regression. In multivariable ordinal regression analysis, severity of CAA-associated vasculopathic changes (OR: 2.40; 95%CI: 1.06–5.45; p=0.035) and CAA presentation with symptomatic ICH (OR: 2.23; 95%CI: 1.07–4.64; p=0.033) were independently associated with the total MRI small vessel disease score. The score was associated with small acute diffusion-weighted imaging lesions and posterior white matter hyperintensities in adjusted analyses. Our study provides evidence for concept validity of a total MRI small vessel disease score in CAA. After further validation, this approach can be potentially used in prospective clinical studies.