Striped occipital cortex and intragyral hemorrhage: Novel magnetic resonance imaging markers for cerebral amyloid angiopathy

Abstract

Background and aim To investigate whether a striped occipital cortex and intragyral hemorrhage, two markers recently detected on ultra-high-field 7-tesla-magnetic resonance imaging in hereditary cerebral amyloid angiopathy (CAA), also occur in sporadic CAA (sCAA) or non-sCAA intracerebral hemorrhage (ICH). Methods We performed 7-tesla-magnetic resonance imaging in patients with probable sCAA and patients with non-sCAA-ICH. Striped occipital cortex (linear hypointense stripes perpendicular to the cortex) and intragyral hemorrhage (hemorrhage restricted to the juxtacortical white matter of one gyrus) were scored on T2*-weighted magnetic resonance imaging. We assessed the association between the markers, other CAA-magnetic resonance imaging markers and clinical features. Results We included 33 patients with sCAA (median age 70 years) and 29 patients with non-sCAA-ICH (median age 58 years). Striped occipital cortex was detected in one (3%) patient with severe sCAA. Five intragyral hemorrhages were found in four (12%) sCAA patients. The markers were absent in the non-sCAA-ICH group. Patients with intragyral hemorrhages had more lobar ICHs (median count 6.5 vs. 1.0), lobar microbleeds (median count >50 vs. 15), and lower median cognitive scores (Mini Mental State Exam: 20 vs. 28, Montreal Cognitive Assessment: 18 vs. 24) compared with patients with sCAA without intragyral hemorrhage. In 12 (36%) patients, sCAA diagnosis was changed to mixed-type small vessel disease due to deep bleeds previously unobserved on lower field-magnetic resonance imaging. Conclusion Whereas a striped occipital cortex is rare in sCAA, 12% of patients with sCAA have intragyral hemorrhages. Intragyral hemorrhages seem to be related to advanced disease and their absence in patients with non-sCAA-ICH could suggest specificity for CAA.

Histopathological Correlates of Lobar Microbleeds in False‐Positive Cerebral Amyloid Angiopathy Cases

“…The second patient (Case 2) was an 80‐year‐old Caucasian male, with 19 years of education, who first presented with cognitive complaints that had begun 2 to 3 years earlier. Baseline MRI showed lobar CMBs, 2 intragyral hemorrhages, 30 lobar lacunes, and WMHs in the posterior periventricular region and CSO. Severe bilateral hippocampal atrophy could also be observed.…”

A Systematic Review evaluating the role of the 7 T MRI in Neurosurgery: Unveiling Trends in the Literature So Far after Clinical Approval in 2017

“…The occurrence of a striped occipital cortex and intragyral hemorrhage, previously detected on ultra-high-field 7-tesla magnetic resonance imaging in hereditary cerebral amyloid angiopathy (CAA) was also investigated. The study aimed to determine whether these markers are also present in sporadic CAA (sCAA) or non-sCAA intracerebral hemorrhage (ICH), contributing to the understanding of imaging markers in different forms of CAA [31]. While a striped occipital cortex is uncommon in superficial cortical siderosis (sCAA), approximately 12% of patients with sCAA exhibit intragyral hemorrhages.…”

“…While a striped occipital cortex is uncommon in superficial cortical siderosis (sCAA), approximately 12% of patients with sCAA exhibit intragyral hemorrhages. These intragyral hemorrhages appear to be associated with advanced disease, and their absence in patients with non-superficial cortical siderosis intracerebral hemorrhages (non-sCAA-ICH) may suggest a level of specificity for cerebral amyloid angiopathy (CAA) [31].…”

Subarachnoid CSF Hyperintensities at 7 Tesla FLAIR MRI: A Novel Marker in Cerebral Amyloid Angiopathy

“…A quadrature transmit and 32-channel receive head coil (Nova Medical, Wilmington, MA, USA) was used and all participants were scanned according to a protocol which has been published in previous studies. (Koemans et al, 2021) The 7T scan protocol contained FLAIR images with the following parameters: repetition time (TR)/echo time (TE): 8000/328 ms, inversion time (TI): 2200 ms, slices with no interslice gap, field-of-view (FOV) 250 × 240 × 180 with a voxel size of 0.8 × 0.8 × 0.8 mm (scan duration 12:08 min), and 2D flow-compensated transverse T 2 *-weighted GRE scanned with the following parameters: TR/TE 1851/25 ms, flip angle 60 degrees, slice thickness 1.0 mm with a 0.1 mm interslice gap, 92 slices (multiband factor 2) and coverage of 10 cm, 240 × 180 × 100 mm FOV, 1000 × matrix sizeresulting in an in-plane spatial resolution of 0.24 × 0.24 mm (scan duration 10 min).…”