Hsin-Hsi Tsai1, Marco Pasi2, Li-Kai Tsai1, Ya-Fang Chen2, Bo-Ching Lee2, Sung-Chun Tang2, Panagiotis Fotiadis2, Chen-Yu Huang2, Ruoh-Fang Yen2, Jiann-Shing Jeng2, M Edip Gurol1. 1. From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei. edip@mail.harvard.edu milikai@ntuh.gov.tw. 2. From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.
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.
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: Marco Pasi; Gregoire Boulouis; Panagiotis Fotiadis; Eitan Auriel; Andreas Charidimou; Kellen Haley; Alison Ayres; Kristin M Schwab; Joshua N Goldstein; Jonathan Rosand; Anand Viswanathan; Leonardo Pantoni; Steven M Greenberg; M Edip Gurol Journal: Neurology Date: 2017-05-05 Impact factor: 9.910
Authors: F Fazekas; R Kleinert; G Roob; G Kleinert; P Kapeller; R Schmidt; H P Hartung Journal: AJNR Am J Neuroradiol Date: 1999-04 Impact factor: 3.825
Authors: Andreas Charidimou; Young T Hong; Hans R Jäger; Zoe Fox; Franklin I Aigbirhio; Tim D Fryer; David K Menon; Elizabeth A Warburton; David J Werring; Jean-Claude Baron Journal: Stroke Date: 2015-04-23 Impact factor: 7.914
Authors: Andreas Charidimou; Gregoire Boulouis; Duangnapa Roongpiboonsopit; Eitan Auriel; Marco Pasi; Kellen Haley; Ellis S van Etten; Sergi Martinez-Ramirez; Alison Ayres; Anastasia Vashkevich; Kristin M Schwab; Joshua N Goldstein; Jonathan Rosand; Anand Viswanathan; Steven M Greenberg; M Edip Gurol Journal: Neurology Date: 2017-10-25 Impact factor: 11.800
Authors: Joanna M Wardlaw; Eric E Smith; Geert J Biessels; Charlotte Cordonnier; Franz Fazekas; Richard Frayne; Richard I Lindley; John T O'Brien; Frederik Barkhof; Oscar R Benavente; Sandra E Black; Carol Brayne; Monique Breteler; Hugues Chabriat; Charles Decarli; Frank-Erik de Leeuw; Fergus Doubal; Marco Duering; Nick C Fox; Steven Greenberg; Vladimir Hachinski; Ingo Kilimann; Vincent Mok; Robert van Oostenbrugge; Leonardo Pantoni; Oliver Speck; Blossom C M Stephan; Stefan Teipel; Anand Viswanathan; David Werring; Christopher Chen; Colin Smith; Mark van Buchem; Bo Norrving; Philip B Gorelick; Martin Dichgans Journal: Lancet Neurol Date: 2013-08 Impact factor: 44.182
Authors: Andreas Charidimou; Gregoire Boulouis; Matthew P Frosch; Jean-Claude Baron; Marco Pasi; Jean Francois Albucher; Gargi Banerjee; Carmen Barbato; Fabrice Bonneville; Sebastian Brandner; Lionel Calviere; François Caparros; Barbara Casolla; Charlotte Cordonnier; Marie-Bernadette Delisle; Vincent Deramecourt; Martin Dichgans; Elif Gokcal; Jochen Herms; Mar Hernandez-Guillamon; Hans Rolf Jäger; Zane Jaunmuktane; Jennifer Linn; Sergi Martinez-Ramirez; Elena Martínez-Sáez; Christian Mawrin; Joan Montaner; Solene Moulin; Jean-Marc Olivot; Fabrizio Piazza; Laurent Puy; Nicolas Raposo; Mark A Rodrigues; Sigrun Roeber; Jose Rafael Romero; Neshika Samarasekera; Julie A Schneider; Stefanie Schreiber; Frank Schreiber; Corentin Schwall; Colin Smith; Levente Szalardy; Pascale Varlet; Alain Viguier; Joanna M Wardlaw; Andrew Warren; Frank A Wollenweber; Marialuisa Zedde; Mark A van Buchem; M Edip Gurol; Anand Viswanathan; Rustam Al-Shahi Salman; Eric E Smith; David J Werring; Steven M Greenberg Journal: Lancet Neurol Date: 2022-08 Impact factor: 59.935
Authors: V Perosa; T Arts; A Assmann; H Mattern; O Speck; J Oltmer; H-J Heinze; E Düzel; S Schreiber; J J M Zwanenburg Journal: AJNR Am J Neuroradiol Date: 2022-03-24 Impact factor: 3.825
Authors: Duncan Wilson; Gareth Ambler; Keon-Joo Lee; Jae-Sung Lim; Masayuki Shiozawa; Masatoshi Koga; Linxin Li; Caroline Lovelock; Hugues Chabriat; Michael Hennerici; Yuen Kwun Wong; Henry Ka Fung Mak; Luis Prats-Sánchez; Alejandro Martínez-Domeño; Shigeru Inamura; Kazuhisa Yoshifuji; Ethem Murat Arsava; Solveig Horstmann; Jan Purrucker; Bonnie Yin Ka Lam; Adrian Wong; Young Dae Kim; Tae-Jin Song; Maarten Schrooten; Robin Lemmens; Sebastian Eppinger; Thomas Gattringer; Ender Uysal; Zeynep Tanriverdi; Natan M Bornstein; Einor Ben Assayag; Hen Hallevi; Jun Tanaka; Hideo Hara; Shelagh B Coutts; Lisa Hert; Alexandros Polymeris; David J Seiffge; Philippe Lyrer; Ale Algra; Jaap Kappelle; Rustam Al-Shahi Salman; Hans R Jäger; Gregory Y H Lip; Heinrich P Mattle; Leonidas D Panos; Jean-Louis Mas; Laurence Legrand; Christopher Karayiannis; Thanh Phan; Sarah Gunkel; Nicolas Christ; Jill Abrigo; Thomas Leung; Winnie Chu; Francesca Chappell; Stephen Makin; Derek Hayden; David J Williams; M Eline Kooi; Dianne H K van Dam-Nolen; Carmen Barbato; Simone Browning; Kim Wiegertjes; Anil M Tuladhar; Noortje Maaijwee; Christine Guevarra; Chathuri Yatawara; Anne-Marie Mendyk; Christine Delmaire; Sebastian Köhler; Robert van Oostenbrugge; Ying Zhou; Chao Xu; Saima Hilal; Bibek Gyanwali; Christopher Chen; Min Lou; Julie Staals; Régis Bordet; Nagaendran Kandiah; Frank-Erik de Leeuw; Robert Simister; Aad van der Lugt; Peter J Kelly; Joanna M Wardlaw; Yannie Soo; Felix Fluri; Velandai Srikanth; David Calvet; Simon Jung; Vincent I H Kwa; Stefan T Engelter; Nils Peters; Eric E Smith; Yusuke Yakushiji; Dilek Necioglu Orken; Franz Fazekas; Vincent Thijs; Ji Hoe Heo; Vincent Mok; Roland Veltkamp; Hakan Ay; Toshio Imaizumi; Beatriz Gomez-Anson; Kui Kai Lau; Eric Jouvent; Peter M Rothwell; Kazunori Toyoda; Hee-Joon Bae; Joan Marti-Fabregas; David J Werring Journal: Lancet Neurol Date: 2019-05-23 Impact factor: 59.935