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Abstract
Objective: To assess whether 18F-florbetapir, a PET amyloid tracer, could bind vascular amyloid in cerebral amyloid angiopathy (CAA) by comparing cortical florbetapir retention during the acute phase between patients with CAA-related lobar intracerebral hemorrhage (ICH) and patients with hypertension-related deep ICH.
Methods: Patients with acute CAA-related lobar ICH were prospectively enrolled and compared with patients with deep ICH. 18F-florbetapir PET, brain MRI, and APOE genotype were obtained for all participants. Cortical florbetapir standard uptake value ratio (SUVr) was calculated with the whole cerebellum used as a reference. Patients with CAA and those with deep ICH were compared for mean cortical florbetapir SUVr values.
Results: Fifteen patients with acute lobar ICH fulfilling the modified Boston criteria for probable CAA (mean age = 67 ± 12 years) and 18 patients with acute deep ICH (mean age = 63 ± 11 years) were enrolled. Mean global cortical florbetapir SUVr was significantly higher among patients with CAA-related ICH than among patients with deep ICH (1.27 ± 0.12 vs 1.12 ± 0.12, p = 0.001). Cortical florbetapir SUVr differentiated patients with CAA-ICH from those with deep ICH (area under the curve = 0.811; 95% confidence interval [CI] 0.642–0.980) with a sensitivity of 0.733 (95% CI 0.475–0.893) and a specificity of 0.833 (95% CI 0.598–0.948).
Conclusions: Cortical florbetapir uptake is increased in patients with CAA-related ICH relative to those with deep ICH. Although 18F-florbetapir PET can label vascular β-amyloid and might serve as an outcome marker in future clinical trials, its diagnostic value in acute CAA-related ICH seems limited in clinical practice.
GLOSSARY
- Aβ=
- β-amyloid;
- AD=
- Alzheimer disease;
- CAA=
- cerebral amyloid angiopathy;
- CI=
- confidence interval;
- CMB=
- cerebral microbleed;
- cSS=
- cortical superficial siderosis;
- FLAIR=
- fluid-attenuated inversion recovery;
- GRE=
- gradient recalled echo;
- ICH=
- intracerebral hemorrhage;
- IQCODE=
- Informant Questionnaire on Cognitive Decline in the Elderly;
- PiB=
- Pittsburgh compound B;
- ROI=
- region of interest;
- STRIVE=
- Standards for Reporting Vascular Changes on Neuroimaging;
- SUV=
- standardized uptake value;
- SUVr=
- standardized uptake value ratio;
- WMH=
- white matter hyperintensities
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received September 30, 2016.
- Accepted in final form May 24, 2017.
- © 2017 American Academy of Neurology
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