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

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)1480-1488
Number of pages9
JournalAlzheimer's and Dementia
Volume11
Issue number12
DOIs
StatePublished - Dec 1 2015

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Cerebral Amyloid Angiopathy
Cerebral Hemorrhage
Magnetic Resonance Imaging
Confidence Intervals
Population
General Hospitals
Hemorrhage
Brain

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Developmental Neuroscience
  • Cellular and Molecular Neuroscience
  • Psychiatry and Mental health
  • Geriatrics and Gerontology
  • Epidemiology
  • Health Policy

Cite this

Martinez-Ramirez, S., Romero, J. R., Shoamanesh, A., McKee, A. C., Van Etten, E., Pontes-Neto, O., ... 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

Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage. / Martinez-Ramirez, Sergi; Romero, Jose Rafael; Shoamanesh, Ashkan; McKee, Ann C.; Van Etten, Ellis; Pontes-Neto, Octavio; Macklin, Eric A.; Ayres, Alison; Auriel, Eitan; Himali, Jayandra J.; Beiser, Alexa S.; DeCarli, Charles; Stein, Thor D.; Alvarez, Victor E.; Frosch, Matthew P.; Rosand, Jonathan; Greenberg, Steven M.; Gurol, M. Edip; Seshadri, Sudha; Viswanathan, Anand.

In: Alzheimer's and Dementia, Vol. 11, No. 12, 01.12.2015, p. 1480-1488.

Research output: Contribution to journalArticle

Martinez-Ramirez, S, Romero, JR, Shoamanesh, A, McKee, AC, Van Etten, E, Pontes-Neto, O, Macklin, EA, Ayres, A, Auriel, E, Himali, JJ, Beiser, AS, DeCarli, C, Stein, TD, Alvarez, VE, Frosch, MP, Rosand, J, Greenberg, SM, Gurol, ME, Seshadri, S & Viswanathan, A 2015, 'Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage', Alzheimer's and Dementia, vol. 11, no. 12, pp. 1480-1488. https://doi.org/10.1016/j.jalz.2015.04.009
Martinez-Ramirez S, Romero JR, Shoamanesh A, McKee AC, Van Etten E, Pontes-Neto O et al. Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage. Alzheimer's and Dementia. 2015 Dec 1;11(12):1480-1488. https://doi.org/10.1016/j.jalz.2015.04.009
Martinez-Ramirez, Sergi ; Romero, Jose Rafael ; Shoamanesh, Ashkan ; McKee, Ann C. ; Van Etten, Ellis ; Pontes-Neto, Octavio ; Macklin, Eric A. ; Ayres, Alison ; Auriel, Eitan ; Himali, Jayandra J. ; Beiser, Alexa S. ; DeCarli, Charles ; Stein, Thor D. ; Alvarez, Victor E. ; Frosch, Matthew P. ; Rosand, Jonathan ; Greenberg, Steven M. ; Gurol, M. Edip ; Seshadri, Sudha ; Viswanathan, Anand. / Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage. In: Alzheimer's and Dementia. 2015 ; Vol. 11, No. 12. pp. 1480-1488.
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AU - Romero, Jose Rafael

AU - Shoamanesh, Ashkan

AU - McKee, Ann C.

AU - Van Etten, Ellis

AU - Pontes-Neto, Octavio

AU - Macklin, Eric A.

AU - Ayres, Alison

AU - Auriel, Eitan

AU - Himali, Jayandra J.

AU - Beiser, Alexa S.

AU - DeCarli, Charles

AU - Stein, Thor D.

AU - Alvarez, Victor E.

AU - Frosch, Matthew P.

AU - Rosand, Jonathan

AU - Greenberg, Steven M.

AU - Gurol, M. Edip

AU - Seshadri, Sudha

AU - Viswanathan, Anand

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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.

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KW - Cerebral amyloid angiopathy

KW - Intracerebral hemorrhage

KW - Likelihood ratio

KW - Microbleed

KW - Predictive value

KW - Sensitivity

KW - Specificity

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