目的:颅内出血(ICH)患者神经影像学上与脑淀粉样血管病(CAA)相关的特征通常与神经影像学上的动脉硬化-小血管病征象共存。这项研究旨在确定通过18FflutemetamolPET检测到的淀粉样蛋白病理学在具有CAA-动脉硬化混合特征的人的再分类和出血风险分层中的价值。
方法:我们纳入了2个机构(2018-2023年)收治的自发性症状性ICH的连续患者,蛛网膜下腔出血(SAH),短暂性局灶性神经系统发作(TFNE),或认知障碍和MRI显示CAA标志。所有患者均接受了脑磁共振成像(MRI),磁敏感加权成像和18FflutemetamolPET成像,并随访至少1年。我们比较了具有CAA和动脉硬化+CAA特征的病例,并确定了长期结局(复合结局包括死亡,ICH,缺血性卒中,SAH,TFNE)取决于PET状态(CAA/淀粉样蛋白病理学与动脉硬化为主组)。
结果:在47例患者中,根据PET和MRI成像,38例患者被重新分类为CAA/淀粉样蛋白病理组,9例患者被重新分类为动脉硬化为主组,心血管危险因素相似,但前一组的叶微出血负担明显更高。与动脉硬化为主组相比,CAA/淀粉样蛋白病理学组的复合结局发生率更高(每100例患者年43.9例事件vs11.1例事件;p=0.039)和ICH(每100例患者年36.5例事件vs5.6例;p=0.04)。
结论:18FFlutemetamolPET显像有助于将混合性动脉硬化+CAA重新分类为CAA/淀粉样病变和以动脉硬化为主的,对复发事件的长期风险有影响。
方法:该研究提供了IV类证据,证明18FflutemetamolPET可以区分CAA动脉粥样硬化和以动脉粥样硬化为主的病理。
OBJECTIVE: Cerebral amyloid angiopathy (CAA)-related features on neuroimaging often coexist with signs of arteriolosclerosis-small vessel disease on neuroimaging in people with intracranial hemorrhage (ICH). This study aimed at defining the value of amyloid pathology detected by 18Fflutemetamol PET in reclassification and stratification of risk of bleeding in people with mixed CAA-arteriolosclerosis features.
METHODS: We included consecutive patients admitted to 2 institutions (2018-2023) with spontaneous symptomatic ICH, subarachnoid hemorrhage (SAH), transient focal neurologic episodes (TFNE), or cognitive impairment and MRI showing CAA hallmarks. All patients underwent brain magnetic resonance imaging (MRI) with susceptibility weighted imaging and 18Fflutemetamol PET imaging and were followed up for at least 1 year. We compared cases with CAA and arteriolosclerosis + CAA features and defined long-term outcomes (composite outcome including death, ICH, ischemic stroke, SAH, TFNE) depending on PET status (CAA/amyloid pathology vs arteriolosclerosis-predominant groups).
RESULTS: Among 47 patients, according to PET and MRI imaging, 38 patients were reclassified in the CAA/amyloid pathology group and 9 in the arteriolosclerosis-predominant group, with similar cardiovascular risk factors but a significantly higher lobar microbleed burden for the former group. The CAA/amyloid pathology group had higher rates of composite outcome (43.9 vs 11.1 events per 100 patient-year; p = 0.039) and ICH (36.5 vs 5.6 events per 100 patient-years; p = 0.04) compared with the arteriolosclerosis-predominant group.
CONCLUSIONS: 18FFlutemetamol PET imaging can help in reclassification of mixed arteriolosclerosis + CAA into CAA/amyloid pathology and arteriolosclerosis-predominant, with implications on long-term risk of recurrent events.
METHODS: This study provides Class IV evidence that 18Fflutemetamol PET can distinguish between CAA + arteriolosclerosis and arteriolosclerosis-predominant pathology.