Clinico-Radiological Characteristics and Pathological Diagnosis of Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage

Abstract

Objective: We aim to clarify the clinico-radiological characteristics of cerebral amyloid angiopathy-related intracerebral hemorrhage and to investigate the efficacy of pathological diagnosis using biopsy specimens. Method: We retrospectively reviewed 253 consecutive patients with cortico-subcortical hemorrhage who had been admitted to Aizawa Hospital between January 2006 and July 2013. We had performed craniotomy and hematoma evacuation in 48 patients, as well as biopsy of the evacuated hematoma, cerebral parenchyma adjacent to the hematoma, or both, and they were classified according to the histological results (positive or negative for vascular amyloid deposition) and to the Boston criteria. We compared the clinicoradiological characteristics of cerebral amyloid angiopathy-related intracerebral hemorrhage. We also investigated the detection rate of cerebral amyloid angiopathy with respect to the origins of the specimens. Results: Pathological examination revealed that 22 subjects were positive for vascular amyloid. The number of the cerebral microbleeds located in the deep or infratentorial region was significantly larger in the negative group than in the positive group (P < .05). There was no significant difference in the distribution of lobar cerebral microbleeds and in the prevalence of hypertension. In the probable cerebral amyloid angiopathyrelated intracerebral hemorrhage patients, the probability of having vascular amyloid detected by biopsy of both hematoma and parenchyma was 100%. Rebleeding in the postoperative periods was observed in 2 cases (9.1%) of the positive group.Conclusions: Our results demonstrate the importance and safety of biopsy simultaneously performed with hematoma evacuation. Deep or infratentorial microbleeds are less correlated with cerebral amyloid angiopathy-related intracerebral hemorrhage than with noncerebral amyloid angiopathy-related intracerebral hemorrhage.

Imaging features of intracerebral hemorrhage with cerebral amyloid angiopathy: Systematic review and meta-analysis

“…Our search strategies identified 1,715 articles of which 22 (one cross-sectional study with controls [10] and 21 case series without controls [11–31]) described CT features of CAA-associated lobar or cerebellar ICH in 297 adults, two studies described MRI features [5,32] in 81 adults and one cross-sectional study [33] described both CT and MRI features in 22 adults (Fig 1). There were no PET studies.…”

“…Of the two retrospective hospital-based cross-sectional studies using CT,[10,33] one included 41 cases [10] and the other 22 cases. [33] Both had a high risk of bias owing to inclusion of selected cases, potential misclassification since not all participants received the same reference standard and an unknown time interval between the index test (brain imaging) and the reference standard (histopathological diagnosis).…”

“…[33] Both had a high risk of bias owing to inclusion of selected cases, potential misclassification since not all participants received the same reference standard and an unknown time interval between the index test (brain imaging) and the reference standard (histopathological diagnosis). The two cross-sectional studies assessing solely MRI were both retrospective hospital-based studies.…”

“…A pre-ICH history of hypertension or dementia were described in 19 (76%) [12,14–19,21–29,31–33] and 14 (56%) studies [11,12,14,15,17,19,22,25,27–31] respectively. Only four (16%) studies stated the interval between symptom onset and the diagnostic scan [20,22,23,31] and six (24%) studies stated the interval between the diagnostic scan and post-mortem or biopsy.…”

Background and distribution of lobar microbleeds in cognitive dysfunction

“…One previous study showed that lobar CMBs were found most frequently in the temporo‐occipital lobes in patients with hypertension‐related intracerebral hemorrhage (ICH), while they were more frequently found in the parietal lobe in patients with CAA‐related ICH (Lee et al., 2007). Another study with patients with cortico‐subcortical hemorrhage showed that lobar CMBs were most numerous in the parietal lobe in patients with CAA pathology (Doden et al., 2016). A hospital‐based study with patients undergoing MRI screening for neurological symptoms revealed that hypertension had a significant association with CMBs in the posterior cerebral artery area (Jia, Mohammed, Qiu, Hong, & Shi, 2014).…”