Background

Diagnosing probable cerebral amyloid angiopathy (CAA) after lobar intra-cerebral hemorrhage (l-ICH) currently relies on the MR-based modified Boston criteria (mBC). However, MRI has limited availability and the mBC have moderate sensitivity, with isolated l-ICH being classified as “possible CAA”. A recent autopsy-based study reported potential value of finger-like projections (FLP) and subarachnoid hemorrhage (SAH) on acute CT. Here we assessed these markers’ performance in a cohort most of whom survived the index episode.

Methods

We included all patients from a prospective pathology database with non-traumatic l-ICH, admission CT and available tissue sample showing no alternative cause. CT was assessed by two blinded independent neuroradiologists. Interobserver reproducibility was almost perfect for SAH and substantial for FLP.

Results

Sixteen patients were eligible [age 65.8 ± 7.2 yrs; hematoma volume: 39(26, 71)mls; hematoma evacuation sample 15 patients; autopsy one patient]. MRI was available in 11 patients. ICH-related death affected six patients. Aβ_40–42 immunohistochemistry revealed CAA in seven patients (44%). SAH and FLP were present in 12/16 (75%) and 10/16 (62%) patients, respectively. SAH had 100% sensitivity for CAA but low specificity; FLP had lower performance. Using either pathology or MRI as reference standard yielded essentially similar results. All patients with possible CAA on MRI but CAA on pathology had SAH.

Conclusions

In patients with moderate-size l-ICH who mostly survived the index event, SAH had perfect sensitivity and better performance than FLP. In addition, SAH appeared to add onto MRI in possible CAA, the clinically most relevant scenario. Studies in larger samples are however warranted.

中文翻译：

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脑淀粉样血管病相关急性大叶脑出血：CT平扫的诊断价值

背景

目前在大叶脑出血 (l-ICH) 后诊断可能的脑淀粉样血管病 (CAA) 依赖于基于 MR 的改良波士顿标准 (mBC)。然而，MRI 的可用性有限，mBC 的敏感性中等，孤立的 l-ICH 被归类为“可能的 CAA”。最近一项基于尸检的研究报告了指状投影 (FLP) 和蛛网膜下腔出血 (SAH) 对急性 CT 的潜在价值。在这里，我们评估了这些标记在一个队列中的表现，其中大多数人在指数事件中幸存下来。

方法

我们纳入了来自前瞻性病理学数据库的所有患者，这些患者具有非创伤性 l-ICH、入院 CT 和可用的组织样本，显示没有其他原因。CT 由两名不知情的独立神经放射科医师评估。观察者间的可重复性对于 SAH 来说几乎是完美的，而对于 FLP 来说是非常重要的。

结果

16 名患者符合条件 [年龄 65.8 ± 7.2 岁；血肿体积：39(26, 71)mls；血肿清除样本15例；尸检一名患者]。11 名患者可进行 MRI 检查。ICH 相关死亡影响了 6 名患者。Aβ _40-42免疫组织化学显示 7 名患者 (44%) 患有 CAA。SAH 和 FLP 分别存在于 12/16 (75%) 和 10/16 (62%) 的患者中。SAH 对 CAA 的敏感性为 100%，但特异性低；FLP 的性能较低。使用病理学或 MRI 作为参考标准产生了基本相似的结果。所有在 MRI 上可能有 CAA 但在病理学上有 CAA 的患者都患有 SAH。

结论

在大多数从指数事件中幸存下来的中等大小的 l-ICH 患者中，SAH 具有完美的敏感性和比 FLP 更好的性能。此外，SAH 似乎在可能的 CAA（临床上最相关的情况）中添加到 MRI 上。然而，需要对更大样本进行研究。