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

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    Abstract

    © 2015 The Alzheimer's Association. 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 languageEnglish
    Pages (from-to)1480-1488
    JournalAlzheimer's and Dementia
    Volume11
    Issue number12
    DOIs
    Publication statusPublished - 1 Dec 2015

    Keywords

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

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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