Scholarlink

Background <p>Diagnosing cerebral amyloid angiopathy (CAA) in primary lobar intracerebral hemorrhage (ICH) remains challenging using routine MRI markers. We investigated a quantitative posterior-dominant pattern of periventricular white matter hyperintensity (PWMH) as a potential supportive imaging feature for CAA within the Boston v2.0 framework.</p> Methods <p>We retrospectively analyzed 229 patients aged ≥ 50 years with primary lobar ICH, classified as CAA (<i>n</i> = 123) or CAA-negative (<i>n</i> = 106) according to the Boston criteria v2.0. On FLAIR, the largest anterior and posterior periventricular WMH areas were measured bilaterally, and the posterior-to-anterior PWMH area ratio (PA-AR) was derived. Multivariable logistic regression models were developed, and diagnostic performance was evaluated using ROC analysis.</p> Results <p>Patients with CAA showed a greater posterior PWMH burden and higher PA-AR than CAA-negative controls (median 1.69 vs. 0.79; <i>p</i> &lt; 0.001). Adding PA-AR to the covariate-adjusted model improved discrimination for CAA (AUC 0.804; bootstrap mean AUC 0.813, 95% CI 0.759–0.867). In the predefined diagnostic “gray zone” subgroup, PA-AR remained informative. The AUC was 0.887 in univariable analysis and 0.888 after age adjustment. PA-AR was also higher in patients with posterior lobar CMBs than in those with no CMBs or mixed-location hemorrhage. </p> Conclusions <p>A posterior-dominant periventricular WMH pattern, quantified by PA-AR, is associated with CAA in lobar ICH. This pattern is also related to posterior-predominant lobar CMB topography. PA-AR may serve as a supportive MRI feature that complements Boston criteria v2.0 markers for identifying CAA within a real-world mixed lobar ICH population, particularly in diagnostically challenging patients.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Posterior-to-anterior periventricular white matter hyperintensity area ratio: a supportive MRI feature for differentiating cerebral amyloid angiopathy in lobar intracerebral hemorrhage

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月26日

查看全文
  • Yingjie Zhang,
  • Sihui Wang,
  • Xinrong Wu,
  • Yao Zhong,
  • Shengjun Sun,
  • Yi Ju

摘要

Background

Diagnosing cerebral amyloid angiopathy (CAA) in primary lobar intracerebral hemorrhage (ICH) remains challenging using routine MRI markers. We investigated a quantitative posterior-dominant pattern of periventricular white matter hyperintensity (PWMH) as a potential supportive imaging feature for CAA within the Boston v2.0 framework.

Methods

We retrospectively analyzed 229 patients aged ≥ 50 years with primary lobar ICH, classified as CAA (n = 123) or CAA-negative (n = 106) according to the Boston criteria v2.0. On FLAIR, the largest anterior and posterior periventricular WMH areas were measured bilaterally, and the posterior-to-anterior PWMH area ratio (PA-AR) was derived. Multivariable logistic regression models were developed, and diagnostic performance was evaluated using ROC analysis.

Results

Patients with CAA showed a greater posterior PWMH burden and higher PA-AR than CAA-negative controls (median 1.69 vs. 0.79; p < 0.001). Adding PA-AR to the covariate-adjusted model improved discrimination for CAA (AUC 0.804; bootstrap mean AUC 0.813, 95% CI 0.759–0.867). In the predefined diagnostic “gray zone” subgroup, PA-AR remained informative. The AUC was 0.887 in univariable analysis and 0.888 after age adjustment. PA-AR was also higher in patients with posterior lobar CMBs than in those with no CMBs or mixed-location hemorrhage.

Conclusions

A posterior-dominant periventricular WMH pattern, quantified by PA-AR, is associated with CAA in lobar ICH. This pattern is also related to posterior-predominant lobar CMB topography. PA-AR may serve as a supportive MRI feature that complements Boston criteria v2.0 markers for identifying CAA within a real-world mixed lobar ICH population, particularly in diagnostically challenging patients.