Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage

Sergi Martinez-Ramirez*, Jose Rafael Romero, Ashkan Shoamanesh, Ann C. McKee, Ellis Van Etten, Octavio Pontes-Neto, Eric A. Macklin, Alison Ayres, Eitan Auriel, Jayandra J. Himali, Alexa S. Beiser, Charles Decarli, Thor D. Stein, Victor E. Alvarez, Matthew P. Frosch, Jonathan Rosand, Steven M. Greenberg, M. Edip Gurol, Sudha Seshadri, Anand Viswanathan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction 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.

Original languageEnglish
Pages (from-to)1480-1488
Number of pages9
JournalAlzheimer's and Dementia
Issue number12
StatePublished - 1 Dec 2015
Externally publishedYes


FundersFunder number
National Institutes of HealthR01 HL076784, 1RO1 HL64753, 1 R01 AG028321
National Institute on AgingP30AG13846, K23AG038444, R01 AG16495, AG033193, AG031287, R01AG008122
National Heart, Lung, and Blood InstituteN01-HC-25195
National Institute of Neurological Disorders and StrokeR01 NS17950
U.S. Department of Veterans Affairs


    • Boston criteria
    • Cerebral amyloid angiopathy
    • Intracerebral hemorrhage
    • Likelihood ratio
    • Microbleed
    • Predictive value
    • Sensitivity
    • Specificity


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