Background

The key imaging features of cerebral amyloid angiopathy (CAA) are lobar, cortical, or cortico-subcortical microbleeds, macrohaemorrhages and cortical superficial siderosis (cSS). In contrast, hypertensive angiopathy is characterized by (micro) haemorrhages in the basal ganglia, thalami, periventricular white matter or the brain stem. Another distinct form of haemorrhagic microangiopathy is mixed cerebral microbleeds (mixed CMB) with features of both CAA and hypertensive angiopathy. The distinction between the two entities (CAA and mixed CMB) is clinically relevant because the risk of haemorrhage and stroke should be well balanced if oral anticoagulation is indicated in CAA patients. We aimed to comprehensively compare these two entities.

Methods

Patients with probable CAA according to the modified Boston criteria and mixed CMB without macrohaemorrhage were retrospectively identified from our database. Comprehensive comparison regarding clinical and radiological parameters was performed between the two cohorts.

Results

Patients with CAA were older (78 ± 8 vs. 74 ± 9 years, p = 0.036) and had a higher prevalence of cSS (19% vs. 4%, p = 0.027) but a lower prevalence of lacunes (73% vs. 50%, p = 0.018) and deep lacunes (23% vs. 51%, p = 0.0003) compared to patients with mixed CMB. Logistic regression revealed an association between the presence of deep lacunes and mixed CMB. The other collected parameters did not reveal a significant difference between the two groups.

Conclusions

CAA and mixed CMB demonstrate radiological differences in the absence of macrohaemorrhages. However, more clinically available biomarkers are needed to elucidate the contribution of CAA and hypertensive angiopathy in mixed CMB patients.

中文翻译：

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可能的脑淀粉样血管病患者和混合性脑微出血患者之间的临床和放射学差异。

背景

脑淀粉样血管病（CAA）的主要影像学特征是大叶，皮质或皮质下皮质微出血，大出血和皮质浅表铁皮病（cSS）。相反，高血压性血管病的特征在于基底神经节，丘脑，脑室周围白质或​​脑干的（微）出血。出血性微血管病的另一种独特形式是混合性脑微出血（混合CMB），具有CAA和高血压性血管病的特征。这两个实体（CAA和混合CMB）之间的区别在临床上是相关的，因为如果在CAA患者中建议口服抗凝治疗，则出血和中风的风险应该得到很好的平衡。我们旨在全面比较这两个实体。

方法

从我们的数据库中回顾性地确定了根据修改后的波士顿标准可能患有CAA的患者和未发生大出血的混合CMB患者。在这两个队列之间进行了有关临床和放射学参数的全面比较。

结果

CAA患者年龄较大（78±8 vs. 74±9岁，p  = 0.036），cSS患病率较高（19％vs. 4％，p  = 0.027），但腔隙炎的患病率较低（73％vs. 73％）。 与混合CMB的患者相比，有 50％的患者，p = 0.018）和深腔（23％比51％，p = 0.0003）。Logistic回归显示深腔和混合CMB之间存在关联。其他收集的参数没有显示两组之间的显着差异。

结论

CAA和混合CMB在没有大出血的情况下显示出放射学差异。但是，需要更多的临床可用生物标志物来阐明混合CMB患者中CAA和高血压血管病的作用。