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Posterior white matter disease distribution as a pbkp_redictor of amyloid angiopathy

Abstract:

Objectives: We sought to examine whether a posterior distribution of white matter hyperintensities (WMH) is an independent pbkp_redictor of pathologically confirmed cerebral amyloid angiopathy (CAA) and whether it is associated with MRI markers of CAA, in patients without lobar intracerebral hemorrhage. Methods: We developed a quantitative method to measure anteroposterior (AP) distribution of WMH. A retrospective cohort of patients without intracerebral hemorrhage and with pathologic evaluation of CAA was examined to determine whether posterior WMH distribution was an independent pbkp_redictor of CAA (n 5 59). The relationship of AP distributions of WMH to strictly lobar microbleeds (MBs) (n 5 259) and location of dilated perivascular spaces (DPVS) (n 5 85) was examined in a separate cohort of patients evaluated in a memory clinic. Results: A more posterior WMH distribution was found to be an independent pbkp_redictor of pathologic evidence of CAA (p 5 0.001, odds ratio [95% confidence interval] 5 1.19 [1.07-1.32]), even in the subgroup without lobar MBs (p 5 0.016, odds ratio [95% confidence interval] 5 1.18 [1.03-1.36]). In the memory clinic cohort, strictly lobar MBs were independently associated with more posterior WMH distribution (p 5 0.009). AP distribution of WMH was also associated with location of DPVS (p 5 0.001), in that patients with predominant DPVS in the white matter over the basal ganglia harbored a more posterior WMH distribution. Conclusions: Our results suggest that AP distribution ofWMH may represent an additional marker of CAA, irrespective of the presence of lobar hemorrhages. Classification of evidence: This study provides Class III evidence that there is a significant association between the AP distribution of WMH on MRI with the presence of pathologically confirmed CAA pathology.