Microangiopathy underlying mixed-location intracerebral hemorrhages/microbleeds: A PiB-PET study.

Abstract

OBJECTIVE:

To 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.

METHODS:

Eighty 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).

RESULTS:

Patients 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.

• Authors: Hsin-Hsi Tsai, Marco Pasi, Li-Kai Tsai, Ya-Fang Chen, Bo-Ching Lee, Sung-Chun Tang, Panagiotis Fotiadis, Chen-Yu Huang, Ruoh-Fang Yen, Jiann-Shing Jeng, M Edip Gurol
• Journal: Neurology (Neurology) Vol. 92 Issue 8 Pg. e774-e781 (02 19 2019) ISSN: 1526-632X [Electronic] United States
• PMID: 30674594 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 American Academy of Neurology.

Chemical References

• 2-(4'-(methylamino)phenyl)-6-hydroxybenzothiazole
• Aniline Compounds
• Thiazoles

Topics

• Aged
• Aged, 80 and over
• Aniline Compounds
• Brain (diagnostic imaging)
• Cerebral Amyloid Angiopathy (complications, diagnostic imaging)
• Cerebral Hemorrhage (diagnostic imaging, etiology)
• Cerebral Small Vessel Diseases (complications, diagnostic imaging)
• Cross-Sectional Studies
• Female
• Humans
• Intracranial Hemorrhage, Hypertensive (diagnostic imaging, etiology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Positron-Emission Tomography
• Taiwan
• Thiazoles