Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy
Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy
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DOI：
10.1212/wnl.0b013e31826043a9
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发表时间：
2012-07-01
期刊：
影响因子：
9.9
通讯作者：
Greenberg, Steven M.
中科院分区：
文献类型：
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作者：
Gurol, M. Edip;Dierksen, Gregory;Greenberg, Steven M.
目的：我们的目的是确定淀粉样蛋白成像是否可以帮助预测的位置和数量的未来血管病变的脑淀粉样蛋白血管病（CAA）。方法：我们进行了一项纵向队列研究的11例CAA患者进行了一系列脑MRI后，基线淀粉样蛋白成像与匹兹堡化合物B（PiB）。在随访MRI上确定的新的微出血/大出血部位确定PiB的平均分布容积比（DVR），并与“模拟”血管中的PiB保留进行比较，使用CAA出血位置的概率分布图随机放置在相同受试者中。还将观察到的新出血部位的平均PiB保留与同心围绕出血部位的髋臼杯中的平均PiB保留进行比较。最后，事件出血和3个区域淀粉样蛋白measurements之间的关联gathered.Results：9的11例受试者至少有一个新的微出血后续MRI（中位数4，四分位数间距[IQR] 1-9）和2个有5个新的脑内出血。在多变量模型中，事件出血部位的平均DVR（1.34，95%置信区间[CI] 1.23-1.46）大于模拟病变（1.14，95% CI 1.07-1.22，p < 0.0001）。PiB保留随着与观察到的出血部位的距离增加而减少（p < 0.0001）。平均DVR在一个上级额叶/旁区的利益独立相关调整后的相关协变量（p = 0.003）与未来的血管扩张的数量。结论：我们的研究结果提供了直接的证据，新的CAA相关血管扩张优先发生在网站的淀粉样蛋白沉积增加，并建议PiB-PET成像可能是一个有用的工具，在预测事件血管扩张CAA患者。神经病学（R）2012;79：320-326
Objective: We aimed to determine whether amyloid imaging can help predict the location and number of future hemorrhages in cerebral amyloid angiopathy (CAA).Methods: We performed a longitudinal cohort study of 11 patients with CAA without dementia who underwent serial brain MRIs after baseline amyloid imaging with Pittsburgh compound B (PiB). Mean distribution volume ratio (DVR) of PiB was determined at the sites of new micro/macrobleeds identified on follow-up MRI and compared with PiB retention at "simulated" hemorrhages, randomly placed in the same subjects using a probability distribution map of CAA-hemorrhage location. Mean PiB retention at the sites of observed new bleeds was also compared to that in shells concentrically surrounding the bleeds. Finally the association between number of incident bleeds and 3 regional amyloid measures were obtained.Results: Nine of 11 subjects had at least one new microbleed on follow-up MRI (median 4, inter-quartile range [IQR] 1-9) and 2 had 5 new intracerebral hemorrhages. Mean DVR was greater at the sites of incident bleeds (1.34, 95% confidence interval [CI] 1.23-1.46) than simulated lesions (1.14, 95% CI 1.07-1.22, p < 0.0001) in multivariable models. PiB retention decreased with increasing distance from sites of observed bleeds (p < 0.0001). Mean DVR in a superior frontal/parasagittal region of interest correlated independently with number of future hemorrhages after adjustment for relevant covariates (p = 0.003).Conclusions: Our results provide direct evidence that new CAA-related hemorrhages occur preferentially at sites of increased amyloid deposition and suggest that PiB-PET imaging may be a useful tool in prediction of incident hemorrhages in patients with CAA. Neurology (R) 2012;79:320-326