|Title:||Microangiopathy underlying mixed-location intracerebral hemorrhages/microbleeds: A PiB-PET study||Authors:||Tsai H.-H.
|Issue Date:||2019||Journal Volume:||92||Journal Issue:||8||Start page/Pages:||E774-E781||Source:||Neurology||Abstract:||
ObjectiveTo test the hypothesis that patients with concomitant lobar and deep intracerebral hemorrhages/microbleeds (mixed ICH) have predominantly hypertensive small vessel disease (HTN-SVD) rather than cerebral amyloid angiopathy (CAA), using in vivo amyloid imaging.MethodsEighty Asian patients with primary ICH without dementia were included in this cross-sectional study. All patients underwent brain MRI and 11C-Pittsburgh compound B (PiB)-PET imaging. The mean cortical standardized uptake value ratio (SUVR) was calculated using cerebellum as reference. Forty-six patients (57.5%) had mixed ICH. Their demographic and clinical profile as well as amyloid deposition patterns were compared to those of 13 patients with CAA-ICH and 21 patients with strictly deep microbleeds and ICH (HTN-ICH).ResultsPatients with mixed ICH were younger (62.8 ± 11.7 vs 73.3 ± 11.9 years in CAA, p = 0.006) and showed a higher rate of hypertension than patients with CAA-ICH (p < 0.001). Patients with mixed ICH had lower PiB SUVR than patients with CAA (1.06 [1.01-1.13] vs 1.43 [1.06-1.58], p = 0.003). In a multivariable logistic regression model, mixed ICH was associated with hypertension (odds ratio 8.9, 95% confidence interval 1.4-58.4, p = 0.02) and lower PiB SUVR (odds ratio 0.03, 95% confidence interval 0.001-0.87, p = 0.04) compared to CAA after adjustment for age. Compared to HTN-ICH, mixed ICH showed a similar mean age (62.8 ± 11.7 vs 60.1 ± 14.5 years in HTN-ICH) and risk factor profile (all p > 0.1). Furthermore, PiB SUVR did not differ between mixed ICH (values presented above) and HTN-ICH (1.10 [1.00-1.16], p = 0.45).Conclusions:Patients with mixed ICH have much lower amyloid load than patients with CAA-ICH, while being similar to HTN-ICH. Overall, mixed ICH is probably caused by HTN-SVD, an important finding with clinical relevance. ? 2019 American Academy of Neurology.
|ISSN:||283878||DOI:||10.1212/WNL.0000000000006953||metadata.dc.subject.other:||Pittsburgh compound B; 2-(4'-(methylamino)phenyl)-6-hydroxybenzothiazole; aniline derivative; thiazole derivative; adult; age distribution; aged; Article; Asian; brain hemorrhage; cerebellum; confidence interval; controlled study; cross-sectional study; demography; female; human; hypertension; in vivo study; major clinical study; male; microangiopathy; multivariate logistic regression analysis; neuroimaging; nuclear magnetic resonance imaging; odds ratio; positron emission tomography; priority journal; risk factor; standardized uptake value ratio; vascular amyloidosis; brain; brain hemorrhage; cerebrovascular disease; complication; diagnostic imaging; middle aged; Taiwan; vascular amyloidosis; very elderly; Aged; Aged, 80 and over; Aniline Compounds; Brain; Cerebral Amyloid Angiopathy; Cerebral Hemorrhage; Cerebral Small Vessel Diseases; Cross-Sectional Studies; Female; Humans; Intracranial Hemorrhage, Hypertensive; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Taiwan; Thiazoles
|Appears in Collections:||醫學院附設醫院 (臺大醫院)|
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