Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage

• DOI: 10.1016/j.jalz.2015.04.009
• Publication Date: 2015-06-14T13:40:19Z
• Authors: Sergi Martinez‐Ra...; 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
• Keywords: Male; Aging; Cerebrovascular; Clinical Sciences; Predictive value; 610; Clinical sciences; Neurodegenerative; Rare Diseases; Sensitivity; Predictive Value of Tests; Vascular Cognitive Impairment/Dementia; Acquired Cognitive Impairment; 80 and over; Humans; Cerebral amyloid angiopathy; Alzheimer's Disease Related Dementias (ADRD); Microbleed; Aged; Cerebral Hemorrhage; Aged, 80 and over; Biomedical and Clinical Sciences; Neurosciences; Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD); Brain; Likelihood ratio; Magnetic Resonance Imaging; Brain Disorders; Boston criteria; 3. Good health; Stroke; Cerebral Amyloid Angiopathy; Geriatrics; Specificity; Biomedical Imaging; Biological psychology; Dementia; Female; Intracerebral hemorrhage

AbstractIntroductionThe 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.MethodsWe 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.ResultsWe 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.DiscussionStrictly 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.