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

doi:10.1016/j.jalz.2015.04.009

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

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115 Scopus citations

Abstract

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 language	English
Pages (from-to)	1480-1488
Number of pages	9
Journal	Alzheimer's and Dementia
Volume	11
Issue number	12
DOIs	https://doi.org/10.1016/j.jalz.2015.04.009
State	Published - 1 Dec 2015
Externally published	Yes

Funding

Funders	Funder number
National Institutes of Health	R01 HL076784, 1RO1 HL64753, 1 R01 AG028321
National Institute on Aging	P30AG13846, K23AG038444, R01 AG16495, AG033193, AG031287, R01AG008122
National Heart, Lung, and Blood Institute	N01-HC-25195
National Institute of Neurological Disorders and Stroke	R01 NS17950
U.S. Department of Veterans Affairs

Keywords

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

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10.1016/j.jalz.2015.04.009

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Martinez-Ramirez, S., Romero, J. R., Shoamanesh, A., McKee, A. C., Van Etten, E., Pontes-Neto, O., Macklin, E. A., Ayres, A., Auriel, E., Himali, J. J., Beiser, A. S., Decarli, C., Stein, T. D., Alvarez, V. E., Frosch, M. P., Rosand, J., Greenberg, S. M., Gurol, M. E., Seshadri, S., & Viswanathan, A. (2015). Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage. Alzheimer's and Dementia, 11(12), 1480-1488. https://doi.org/10.1016/j.jalz.2015.04.009

@article{281a2b44b726476fbe9618a42184356f,

title = "Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage",

abstract = "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.",

keywords = "Boston criteria, Cerebral amyloid angiopathy, Intracerebral hemorrhage, Likelihood ratio, Microbleed, Predictive value, Sensitivity, Specificity",

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

note = "Publisher Copyright: {\textcopyright} 2015 The Alzheimer's Association.",

year = "2015",

month = dec,

day = "1",

doi = "10.1016/j.jalz.2015.04.009",

language = "אנגלית",

volume = "11",

pages = "1480--1488",

journal = "Alzheimer's and Dementia",

issn = "1552-5260",

publisher = "John Wiley and Sons Inc.",

number = "12",

}

Martinez-Ramirez, S, Romero, JR, Shoamanesh, A, McKee, AC, Van Etten, E, Pontes-Neto, O, Macklin, EA, Ayres, A, Auriel, E, Himali, JJ, Beiser, AS, Decarli, C, Stein, TD, Alvarez, VE, Frosch, MP, Rosand, J, Greenberg, SM, Gurol, ME, Seshadri, S & Viswanathan, A 2015, 'Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage', Alzheimer's and Dementia, vol. 11, no. 12, pp. 1480-1488. https://doi.org/10.1016/j.jalz.2015.04.009

TY - JOUR

T1 - Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage

AU - Martinez-Ramirez, Sergi

AU - Romero, Jose Rafael

AU - Shoamanesh, Ashkan

AU - McKee, Ann C.

AU - Van Etten, Ellis

AU - Pontes-Neto, Octavio

AU - Macklin, Eric A.

AU - Ayres, Alison

AU - Auriel, Eitan

AU - Himali, Jayandra J.

AU - Beiser, Alexa S.

AU - Decarli, Charles

AU - Stein, Thor D.

AU - Alvarez, Victor E.

AU - Frosch, Matthew P.

AU - Rosand, Jonathan

AU - Greenberg, Steven M.

AU - Gurol, M. Edip

AU - Seshadri, Sudha

AU - Viswanathan, Anand

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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.

AB - 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.

KW - Boston criteria

KW - Cerebral amyloid angiopathy

KW - Intracerebral hemorrhage

KW - Likelihood ratio

KW - Microbleed

KW - Predictive value

KW - Sensitivity

KW - Specificity

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JO - Alzheimer's and Dementia

JF - Alzheimer's and Dementia

IS - 12

ER -

Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage

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