Journal
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Volume 34, Issue 5, Pages 753-758Publisher
SAGE PUBLICATIONS INC
DOI: 10.1038/jcbfm.2014.43
Keywords
cerebral amyloid angiopathy; imaging; intracerebral hemorrhage; positron emission tomography
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Funding
- Cambridge Comprehensive Biomedical Centre
- MRC [G0900903] Funding Source: UKRI
- Medical Research Council [G0900903, G0001354B, G1000183B, G0001354] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0512-10090] Funding Source: researchfish
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By detecting beta-amyloid (A beta) in the wall of cortical arterioles, amyloid positron emission tomography (PET) imaging might help diagnose cerebral amyloid angiopathy (CAA) in patients with lobar intracerebral hemorrhage (l-ICH). No previous study has directly assessed the diagnostic value of C-11-Pittsburgh compound B (PiB) PET in probable CAA-related l-ICH against healthy controls (HCs). C-11-PiB-PET and magnetic resonance imaging (MRI) including T2* were obtained in 11 nondemented patients fulfilling the Boston criteria for probable CAA-related symptomatic l-ICH (sl-ICH) and 20 HCs without cognitive complaints or impairment. After optimal spatial normalization, cerebral spinal fluid (CSF)-corrected PiB distribution volume ratios (DVRs) were obtained. There was no significant difference in whole cortex or regional DVRs between CAA patients and age-matched HCs. The whole cortex DVR was above the 95% confidence limit in 4/9 HCs and 10/11 CAA patients (sensitivity = 91%, specificity = 55%). Region/frontal or occipital ratios did not have better discriminative value. Similar but less accurate results were found using visual analysis. In patients with sl-ICH, C-11-PiB-PET has low specificity for CAA due to the frequent occurrence of high C-11-PiB uptake in the healthy elderly reflecting incipient Alzheimer's disease (AD), which might also be present in suspected CAA. However, a negative PiB scan rules out CAA with excellent sensitivity, which has clinical implications for prognostication and selection of candidates for drug trials.
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