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

Alzheimers Dement. 2015 Dec;11(12):1480-1488. doi: 10.1016/j.jalz.2015.04.009. Epub 2015 Jun 13.

Authors

Sergi Martinez-Ramirez¹, Jose-Rafael Romero², Ashkan Shoamanesh³, Ann C McKee⁴, Ellis Van Etten⁵, Octavio Pontes-Neto⁵, Eric A Macklin⁶, Alison Ayres⁵, Eitan Auriel⁵, Jayandra J Himali⁷, Alexa S Beiser⁸, Charles DeCarli⁹, Thor D Stein¹⁰, Victor E Alvarez¹¹, Matthew P Frosch¹², Jonathan Rosand¹³, Steven M Greenberg⁵, M Edip Gurol⁵, Sudha Seshadri², Anand Viswanathan⁵

Affiliations

¹ Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA; Escola de Postgrau, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: srmartinez@mgh.harvard.edu.
² Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA.
³ Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA.
⁴ Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA; Department of Pathology, School of Medicine, Boston University, Boston, MA, USA; United States Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA.
⁵ Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA.
⁷ NHLBI's Framingham Heart Study, Framingham, MA, USA; Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA.
⁸ Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA; Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA.
⁹ Department of Neurology, University of California-Davis, Sacramento, CA, USA.
¹⁰ Department of Pathology, School of Medicine, Boston University, Boston, MA, USA; United States Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA.
¹¹ Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; Center for the Study of Traumatic Encephalopathy, Boston University Alzheimer Disease Center, Boston, MA, USA.
¹² Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Charlestown, MA, USA.
¹³ Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Aged, 80 and over
Brain / pathology*
Cerebral Amyloid Angiopathy / complications
Cerebral Amyloid Angiopathy / diagnosis*
Cerebral Amyloid Angiopathy / pathology
Cerebral Hemorrhage / etiology
Cerebral Hemorrhage / pathology*
Female
Humans
Magnetic Resonance Imaging
Male
Predictive Value of Tests

Abstract

Publication types

MeSH terms

Grants and funding