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Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage
Author(s) -
MartinezRamirez Sergi,
Romero JoseRafael,
Shoamanesh Ashkan,
McKee Ann C.,
Van Etten Ellis,
PontesNeto Octavio,
Macklin Eric A.,
Ayres Alison,
Auriel Eitan,
Himali Jayandra J.,
Beiser Alexa S.,
DeCarli Charles,
Stein Thor D.,
Alvarez Victor E.,
Frosch Matthew P.,
Rosand Jonathan,
Greenberg Steven M.,
Gurol M. Edip,
Seshadri Sudha,
Viswanathan Anand
Publication year - 2015
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2015.04.009
Subject(s) - cerebral amyloid angiopathy , medicine , intracerebral hemorrhage , context (archaeology) , framingham heart study , magnetic resonance imaging , confidence interval , population , pathological , dementia , radiology , framingham risk score , disease , subarachnoid hemorrhage , paleontology , environmental health , biology
The Boston criteria are the basis for a noninvasive diagnosis of cerebral amyloid angiopathy (CAA) in the setting of lobar intracerebral hemorrhage (ICH). We assessed the accuracy of these criteria in individuals with lobar microbleeds (MBs) without ICH. Methods We identified individuals aged >55 years having brain magnetic resonance imaging (MRI) and pathological assessment of CAA in a single academic hospital and a community‐based population (Framingham Heart Study [FHS]). We determined the positive predictive value (PPV) of the Boston criteria for CAA in both cohorts, using lobar MBs as the only hemorrhagic lesion to fulfill the criteria. Results We included 102 individuals: 55 from the hospital‐based cohort and 47 from FHS (mean age at MRI 74.7 ± 8.5 and 83.4 ± 10.9 years; CAA prevalence 60% and 46.8%; cases with any lobar MB 49% and 21.3%; and cases with ≥2 strictly lobar MBs 29.1% and 8.5%, respectively). PPV of “probable CAA” (≥2 strictly lobar MBs) was 87.5% (95% confidence interval [CI], 60.4–97.8) and 25% (95% CI, 13.2–78) in hospital and general populations, respectively. Discussion Strictly lobar MBs strongly predict CAA in non‐ICH individuals when found in a hospital context. However, their diagnostic accuracy in the general population appears limited.