Centrum Semiovale Perivascular Space and Amyloid Deposition in Spontaneous Intracerebral Hemorrhage

Abstract

Background and Purpose: We explored whether high-degree magnetic resonance imaging–visible perivascular spaces in centrum semiovale (CSO) are more prevalent in cerebral amyloid angiopathy (CAA) than hypertensive small vessel disease and their relationship to brain amyloid retention in patients with primary intracerebral hemorrhage (ICH). Methods: One hundred and eight spontaneous ICH patients who underwent magnetic resonance imaging and Pittsburgh compound B were enrolled. Topography and severity of enlarged perivascular spaces were compared between CAA-related ICH (CAA-ICH) and hypertensive small vessel disease–related ICH (non-CAA ICH). Clinical and image characteristics associated with high-degree perivascular spaces were evaluated in univariate and multivariable analyses. Univariate and multivariable models were performed to evaluate associations between the severity of perivascular spaces in CSO and amyloid retention in CAA-ICH and non–CAA-ICH cases. Results: Patients with CAA-ICH (n=29) and non–CAA-ICH (n=79) had similar prevalence of high-degree perivascular spaces in CSO (44.8% versus 36.7%; P =0.507) and in basal ganglia (34.5% versus 51.9%; P =0.131). High-degree perivascular spaces in CSO were independently associated with the presence of lobar microbleed (odds ratio, 3.0 [95% CI, 1.1–8.0]; P =0.032). The amyloid retention was higher in those with high-degree than those with low-degree CSO-perivascular spaces in CAA-ICH (global Pittsburgh compound B standardized uptake value ratio, 1.55 [1.33–1.61] versus 1.13 [1.01–1.48]; P =0.003) but not in non–CAA-ICH. In CAA-ICH, the association between cerebral amyloid retention and the degree of perivascular spaces in CSO remained significant after adjustment for age and lobar microbleed number ( P =0.004). Conclusions: Although high-degree magnetic resonance imaging–visible perivascular spaces are equally prevalent between CAA-ICH and non–CAA-ICH in the Asian cohort, the severity of magnetic resonance imaging–visible CSO-perivascular spaces may be an indicator of higher brain amyloid deposition in patients with CAA-ICH.

Radiological assessment of dementia: the Italian inter-society consensus for a practical and clinically oriented guide to image acquisition, evaluation, and reporting

“…[ 9 , 33 , 37 ] Δ The early-phase 11c-PiB PET help differentiate probable CAA from probable AD. Early-phase amyloid PET images are used as a surrogate for brain perfusion, as opposed to the standard late-phase 11c-PiB PET/CT which reflects binding to aβ deposits ◊ When predominantly placed in the centrum semiovale, the dilated perivascular spaces are frequently associated with CAA [ 72 ] § Microbleeds are not specific for CAA as they can be seen in multiple conditions, including, hypertension, cerebral cavernous malformations, coagulopathy, thrombocytopenia, anticoagulant medications, CNS vasculitis, infective endocarditis, end-stage kidney failure. Moreover, beside conditions above-mentioned, microbleeds are also more prevalent among users of antiplatelet agents [ 24 ].…”

“…◊ When predominantly placed in the centrum semiovale, the dilated perivascular spaces are frequently associated with CAA [ 72 ]…”

Cerebral Venous Reflux and Dilated Basal Ganglia Perivascular Space in Hypertensive Intracerebral Hemorrhage

“…We also excluded patients with CAA-related ICH to avoid the potential confounding effect of the different topographical distribution of damaged vessels in β-amyloid disorders. 16 Further study focusing on CVR in CAA to delineate the complex relationships between β-amyloid deposition, venous flow alterations and SVD injuries to the brain should be done. Finally, the sample size in this study was relatively small and our cross-sectional design could not assess the causality between CVR and PVS enlargement.…”

PET imaging for the evaluation of cerebral amyloid angiopathy: a systematic review

“…Furthermore, the role of PET imaging with 11 C-PIB for the differential diagnosis between CAA and other conditions related to cerebral hemorrhage has been proven in some studies [18,28,32,37,42].…”

“…In this setting Ly et al [18] reported increased 11 C-PIB uptake in patients with CAA-related hemorrhage (CAAH) and higher binding of tracer in patients with probable CAAH compared to patients with possible CAAH. Four different studies by the group of Tsai et al [28,32,37,42] reported higher 11 C-PIB retention in CAA-ICH patients compared to non-CAA-ICH patients (hypertensive and mixed ICH) and a correlation between lobar lacune counts and SUV values. Furthermore, higher tracer uptake in patients with high-degree enlarged centrum semiovale perivascular spaces (ECSPVS) compared to low-degree patients was reported.…”