Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy

M. Edip Gurol, Gregory Dierksen, Rebecca Betensky, Christopher Gidicsin, Amy Halpin, Alex Becker, Jeremy Carmasin, Alison Ayres, Kristin Schwab, Anand Viswanathan, David Salat, Jonathan Rosand, Keith A. Johnson, Steven M. Greenberg

Research output: Contribution to journalArticle

Abstract

We aimed to determine whether amyloid imaging can help predict the location and number of future hemorrhages in cerebral amyloid angiopathy (CAA). We performed a longitudinal cohort study of 11 patients with CAA without dementia who underwent serial brain MRIs after baseline amyloid imaging with Pittsburgh compound B (PiB). Mean distribution volume ratio (DVR) of PiB was determined at the sites of new micro/macrobleeds identified on follow-up MRI and compared with PiB retention at “simulated” hemorrhages, randomly placed in the same subjects using a probability distribution map of CAA-hemorrhage location. Mean PiB retention at the sites of observed new bleeds was also compared to that in shells concentrically surrounding the bleeds. Finally the association between number of incident bleeds and 3 regional amyloid measures were obtained. Nine of 11 subjects had at least one new microbleed on follow-up MRI (median 4, interquartile range [IQR] 1-9) and 2 had 5 new intracerebral hemorrhages. Mean DVR was greater at the sites of incident bleeds (1.34, 95% confidence interval [CI] 1.23-1.46) than simulated lesions (1.14, 95% CI 1.07-1.22, p < 0.0001) in multivariable models. PiB retention decreased with increasing distance from sites of observed bleeds (p < 0.0001). Mean DVR in a superior frontal/parasagittal region of interest correlated independently with number of future hemorrhages after adjustment for relevant covariates (p = 0.003). Our results provide direct evidence that new CAA-related hemorrhages occur preferentially at sites of increased amyloid deposition and suggest that PiB-PET imaging may be a useful tool in prediction of incident hemorrhages in patients with CAA. Aβ: β-amyloid CAA: cerebral amyloid angiopathy CI: confidence interval DVR: distribution volume ratio IQR: interquartile range PiB: Pittsburgh compound B ROI: region of interest SWI: susceptibility-weighted imaging.

Original languageEnglish (US)
Pages (from-to)320-326
Number of pages7
JournalNeurology
Volume79
Issue number4
DOIs
StatePublished - Jan 1 2012

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Cerebral Amyloid Angiopathy
Amyloid
Hemorrhage
Confidence Intervals
2-(4'-(methylamino)phenyl)-6-hydroxybenzothiazole
Cerebral Hemorrhage
Longitudinal Studies
Dementia
Cohort Studies

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Gurol, M. E., Dierksen, G., Betensky, R., Gidicsin, C., Halpin, A., Becker, A., ... Greenberg, S. M. (2012). Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy. Neurology, 79(4), 320-326. https://doi.org/10.1212/WNL.0b013e31826043a9

Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy. / Gurol, M. Edip; Dierksen, Gregory; Betensky, Rebecca; Gidicsin, Christopher; Halpin, Amy; Becker, Alex; Carmasin, Jeremy; Ayres, Alison; Schwab, Kristin; Viswanathan, Anand; Salat, David; Rosand, Jonathan; Johnson, Keith A.; Greenberg, Steven M.

In: Neurology, Vol. 79, No. 4, 01.01.2012, p. 320-326.

Research output: Contribution to journalArticle

Gurol, ME, Dierksen, G, Betensky, R, Gidicsin, C, Halpin, A, Becker, A, Carmasin, J, Ayres, A, Schwab, K, Viswanathan, A, Salat, D, Rosand, J, Johnson, KA & Greenberg, SM 2012, 'Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy', Neurology, vol. 79, no. 4, pp. 320-326. https://doi.org/10.1212/WNL.0b013e31826043a9
Gurol ME, Dierksen G, Betensky R, Gidicsin C, Halpin A, Becker A et al. Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy. Neurology. 2012 Jan 1;79(4):320-326. https://doi.org/10.1212/WNL.0b013e31826043a9
Gurol, M. Edip ; Dierksen, Gregory ; Betensky, Rebecca ; Gidicsin, Christopher ; Halpin, Amy ; Becker, Alex ; Carmasin, Jeremy ; Ayres, Alison ; Schwab, Kristin ; Viswanathan, Anand ; Salat, David ; Rosand, Jonathan ; Johnson, Keith A. ; Greenberg, Steven M. / Predicting sites of new hemorrhage with amyloid imaging in cerebral amyloid angiopathy. In: Neurology. 2012 ; Vol. 79, No. 4. pp. 320-326.
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