一刀切:脑淀粉样变性血管病的微中型和大型出血。

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Cerebrovascular Diseases Pub Date : 2024-08-19 DOI:10.1159/000540899
Emma A Koemans, Thijs W van Harten, Sabine Voigt, Ingeborg Rasing, Erik W van Zwet, Gisela M Terwindt, Matthias J P van Osch, Marianne A A van Walderveen, Marieke J H Wermer
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引用次数: 0

摘要

导言:小血管疾病标记物的磁共振成像评级标准包括微出血和大出血的定义,但不包括具有囊腔和/或不规则形状的小出血(10 毫米)。然而,脑淀粉样变性血管病(CAA)患者通常会出现此类出血。本研究旨在调查 CAA 患者中此类出血(我们称之为中出血)的频率、直径和体积分布:我们选择了荷兰型遗传性(D-CAA)和散发性(s)CAA 患者,并在 3T 磁共振成像(SWI)上对微出血、中出血和大出血进行了评分。使用半自动工具计算了一部分参与者的出血直径和出血量,并对其分布进行了对数评估:我们纳入了 25 名 D-CAA 患者(平均年龄 56 岁)和 25 名 sCAA 患者(平均年龄 73 岁)。共观察到 11007 个微小出血点、602 个中出血点和 195 个大出血点。82%的参与者有≥1处间隙出血。对 4 名参与者的出血直径和出血量进行了计算,其中微出血 272 例(中位数直径 1.52 毫米,出血量 0.004 毫升),中出血 84 例(中位数直径 5.61 毫米,出血量 0.06 毫升),大出血 37 例(中位数直径 19.58 毫米,出血量 1.33 毫升)。中间出血的直径和体积大于微出血(最佳截断值为 0.02 毫升),但与大出血有重叠:结论:在 CAA 患者中经常发现形状不规则和/或囊腔的 10 毫米出血,其直径和体积分布明显。我们建议将这些出血命名为 "中出血",并将其与 "微出血 "和 "大出血 "区分开来。未来有必要对其病理生理学和预后价值进行研究。
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One Size Does Not Fit All: Micro-, Meso-, and Macrobleeds in Cerebral Amyloid Angiopathy.

Introduction: MRI rating criteria for small vessel disease markers include definitions for microbleeds and macrobleeds but do not account for small (<10 mm) hemorrhages with a cystic cavity and/or irregular shape. Such hemorrhages, however, are often present in patients with cerebral amyloid angiopathy (CAA). In this study, we aimed to investigate the frequency, diameter, and volume distribution of these hemorrhages (which we called mesobleeds) in patients with CAA.

Methods: We selected participants with Dutch-type hereditary CAA (D-CAA) and sporadic CAA (sCAA) and scored microbleeds, mesobleeds, and macrobleeds on 3T susceptibility-weighted images MRI. Hemorrhage diameter and volume were calculated in a subset of participants using a semi-automatic tool; their distribution was evaluated on a logarithmic scale.

Results: We included 25 participants with D-CAA (mean age 56 years) and 25 with sCAA (mean age 73 years). In total, 11,007 microbleeds, 602 mesobleeds, and 195 macrobleeds were observed. Eighty-two percent of participants had ≥1 mesobleed. Hemorrhage diameter and volume were calculated in four participants with 272 microbleeds (median diameter 1.52 mm, volume 0.004 mL), 84 mesobleeds (median diameter 5.61 mm, volume 0.06 mL), and 37 macrobleeds (median diameter 19.58 mm, volume 1.33 mL). Mesobleed diameter and volume were larger than microbleeds (optimal cut-off 0.02 mL) but showed overlap with macrobleeds.

Conclusion: Hemorrhages <10 mm with an irregular shape and/or cystic cavity are frequently found in participants with CAA and have a distinct diameter and volume distribution. We propose to name these hemorrhage mesobleeds and to rate them separately from micro- and macrobleeds. Future research is necessary to investigate their pathophysiology and prognostic value.

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来源期刊
Cerebrovascular Diseases
Cerebrovascular Diseases 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
90
审稿时长
1 months
期刊介绍: A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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