Diagnosis of Cerebral Amyloid Angiopathy: Evolution of the Boston Criteria.
Diagnosis of Cerebral Amyloid Angiopathy: Evolution of the Boston Criteria.
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DOI：
10.1161/strokeaha.117.016990
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发表时间：
2018-03
期刊：
影响因子：
8.3
通讯作者：
Charidimou A
中科院分区：
文献类型：
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作者：
Greenberg SM;Charidimou A
492卒中2018年2月可能发生CAA所需的肺叶出血，或者如果位于深部地区则排除可能的CAA。统计所有类型出血性病变的理由是，尽管不同的致病机制可能导致不同的出血大小，14但每一种都可能代表不同的血管渗漏事件，因此为潜在的小血管状况提供了独立的证据。血液敏感的T2加权MRI方法的日益广泛使用极大地影响了CMBS(图1)和CS(图2)的检测，从而影响了CAA的诊断，如下所述。相反，可能是较大出血的一部分的出血性病变，如较大出血附近的较小范围，或邻近或直接连接到蛛网膜下腔的脑出血的CS灶，被视为单一出血事件的一部分，因此不计入单独的出血(图1C和2C)。第二个实际问题是，由于皮质回的起伏曲线，半卵圆中心的出血性病变看起来离大脑外表面很远，但仍然非常接近皮质下交界处(图1D)。只有当出血明显累及基底节、丘脑或内囊时，才被认为是半球深部出血。
492 Stroke February 2018 lobar hemorrhages required for probable CAA, or alternatively preclude probable CAA if in deep territories. The rationale for counting all types of hemorrhagic lesions is that while different hemorrhage sizes may arise by distinct pathogenic mechanisms, 14 each presumably represents a distinct event of vessel leakage and therefore provides independent evidence for the underlying small-vessel condition. The increasingly widespread use of blood-sensitive T2*-weighted MRI methods has greatly influenced detection of CMBs (Figure 1) and cSS (Figure 2) and thus the diagnosis of CAA as discussed below. Conversely hemorrhagic lesions that may be part of a larger hemorrhage, such as smaller extensions in proximity to a larger hemorrhage or foci of cSS near or directly connected to ICHs that have ruptured into the subarachnoid space, are considered as part of a single bleeding event and thus not counted as separate hemorrhages (Figures 1C and 2C). A second practical issue is that a hemorrhagic lesion in the centrum semiovale can seem a long distance from the outer surface of the brain and still be quite close to the corticosubcortical junction (Figure 1D) because of the undulating curves of the cortical gyri. Hemorrhages are considered deep hemispheric only when clearly involving the basal ganglia, thalamus, or internal capsule.