Microenhancement as a Biomarker for Cerebral Microbleed in Inflammatory Cerebral Amyloid Angiopathy: Insights From 3D T1 Black-Blood MR Imaging.

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY Neurology Pub Date : 2025-01-28 Epub Date: 2025-01-02 DOI:10.1212/WNL.0000000000210258

Ty Shang, Peter V Sguigna, Marco C Pinho, William Moore, Erica Jones, Suriya Subramanian, Parth Upadhyaya, Brendan Kelley, Kimmo J Hatanpaa, Jack Raisanen

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Abstract

Objectives: Cerebral microbleeds (cMBs) are common imaging findings in conditions related to cerebral amyloid angiopathy (CAA). Blood-brain barrier (BBB) leakage is considered pivotal in their pathogenesis. This study investigates the potential role of cerebral microenhancement (cME) as an imaging biomarker on 3D T1 black-blood MRI (BB-MRI) for BBB rupture, predicting the formation of cMBs in inflammatory CAA variants.

Methods: A retrospective review was conducted on biopsy-confirmed cases of CAA-related inflammation (CAA-ri) and amyloid-beta-related angiitis (ABRA) from the UT Southwestern Medical Center's BB-MRI registry (2014-2022). Subjects underwent 3D T1 BB MRI and susceptibility-weighted imaging. The presence and progression of cMEs and cMBs were assessed.

Results: A total of 5 subjects (1 CAA-ri, 4 ABRA) were identified. Frequent cMEs on 3D T1 BB MRI scans preceded cMB formation, particularly in subjects with the ApoE ɛ4/4 genotype experiencing a refractory clinical course. Stable subjects had fewer cMEs and cMBs.

Discussion: The presence of cME before cMB suggests their potential as a biomarker for cMB formation. The findings align with the hypothesis that BBB rupture and focal inflammation are critical in cMB pathogenesis. Further validation of 3D T1 BB MRI as an assessment tool for cMB formation in inflammatory CAA based on clinicoradiologic diagnosis and noninflammatory CAA could enhance monitoring and treatment strategies.

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目的：脑微小出血（cMBs）是脑淀粉样血管病（CAA）相关疾病的常见影像学检查结果。血脑屏障（BBB）渗漏被认为是其发病机制的关键。本研究探讨了脑微强化（cME）作为三维T1黑血磁共振成像（BB-MRI）的成像生物标志物对BBB破裂的潜在作用，并预测炎症性CAA变体中cMB的形成：我们对UT西南医学中心BB-MRI登记（2014-2022年）中活检证实的CAA相关炎症（CAA-ri）和淀粉样β相关血管炎（ABRA）病例进行了回顾性研究。受试者接受了三维 T1 BB MRI 和感度加权成像。结果：结果：共确定了 5 名受试者（1 名 CAA-ri，4 名 ABRA）。在cMB形成之前，三维T1 BB磁共振成像扫描中经常出现cME，尤其是在临床病程难治的载脂蛋白Eɛ4/4基因型受试者中。病情稳定的受试者的cME和cMB都较少：讨论：cME 出现在 cMB 之前，表明它们有可能成为 cMB 形成的生物标志物。这些发现与 BBB 破裂和局灶性炎症在 cMB 发病机制中起关键作用的假设一致。根据临床放射学诊断和非炎症性CAA，进一步验证三维T1 BB MRI作为炎症性CAA中cMB形成的评估工具，可加强监测和治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.