The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI–neuropathology diagnostic accuracy study

Charidimou, Andreas; Boulouis, Grégoire; Frosch, Matthew P.; Baron, Jean-Claude; Pasi, Marco; Albucher, Jean François; Banerjee, Gargi; Barbato, Carmen; Bonneville, Fabrice; Brandner, Sebastian; Calvière, Lionel; Caparros, François; Casolla, Barbara; Cordonnier, Charlotte; Delisle, Marie–Bernadette; Deramecourt, Vincent; Dichgans, Martin; Gökçal, Elif; Herms, Jochen; Hernández-Guillamón, Mar; Jäger, Hans Rolf; Jaunmuktane, Zane; Linn, Jennifer; Martínez-Ramírez, Sergi; Martínez‐Sáez, Elena; Mawrin, Christian; Montaner, Joan; Moulin, Solène; Olivot, Jean‐Marc; Piazza, Fabrizio; Puy, Laurent; Raposo, Nicolas; Rodrigues, Mark; Roeber, Sigrun; Romero, José R.; Samarasekera, Neshika; Schneider, Julie A.; Schreiber, Stefanie; Schreiber, Frank; Schwall, Corentin; Smith, Colin; Szalárdy, Levente; Varlet, Pascale; Viguier, Alain; Wardlaw, Joanna M.; Warren, Andrew; Wollenweber, Frank Arne; Zedde, Marialuisa; Buchem, Mark A. van; Gurol, M. Edip; Viswanathan, Anand; Salman, Rustam Al‐Shahi; Smith, Eric E.; Werring, David J.; Greenberg, Steven M.

doi:10.1016/s1474-4422(22)00208-3

Cited by 201 publications

(182 citation statements)

References 41 publications

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“…: lobar, non-lobar or mixed 90 . The former is associated with cerebral amyloid angiopathy, quantifiable by the Boston Criteria, 91 later extended to other patterns as in chronic hypertensive encephalopathy 55,56 (figs 5 and 7).…”

Section: Acute On Chronic Encephalopathymentioning

confidence: 83%

Neuroimaging Findings in Symptomatic Hypertensive Encephalopathy

Bertoni

Webb

Balogun

et al. 2022

MRAJ

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To assess the relevance clinicians and radiologists assign to making hypertension (HTN) explicit in acutely symptomatic subjects admitted for either stroke, confusion or cognitive deficit, a revision was carried out of cases discussed in our institution in the last eleven years, at either the Neuroradiology-Stroke or the Neuropsychiatry multidisciplinary meetings (MDTs). Consistency of the provided clinical information and radiological findings concerning HTN were checked in 11810 subjects (Group 1), since both influence neuroimaging interpretation, diagnosis and management. Similar information was collected in a subgroup of 25 subjects (Group 2), with signs of stroke included in Group 1 in whom there was pre-existent history of severe HTN, who were evaluated with multimodality neuroimaging in 48 hours from admission and who had improved clinically in 72 hours. The word “hypertension” included in the initial neuroimaging request, blood pressure (BP) levels on admission, radiology reports describing intra axial bleed, mentioning “hypertensive encephalopathy”, “chronic hypertensive encephalopathy”, “hypertensive microbleeds”, “amyloid microbleeds”, features and quantification of cerebral small vessel disease (CSVD), a non-specific pattern of cortical atrophy, dolicoarteriopathy, presence and degree of carotid or vertebrobasilar stenosis were tabled. Electronic records of blood pressure (BP) were available in 10003/11810 cases and in written notes in 1807/11810; 1582/11810 were not hypertensive and 8421/11810 hypertensive. Imaging requests did explicitly include the word “hypertension” in 1184/11810. Radiology reported acute intracranial bleed on admission in 1516/11810, hypertensive encephalopathy in 248/11810, chronic hypertensive encephalopathy in 148/11810, hypertensive-type microbleeds in 295/11810, amyloid-type microbleeds in 390/11810, SVD features without quantification in 1554/11810, SVD 1/3 in 577/11810, SVD 2/3 in 1402/11810, SVD 3/3 in 776/11810, non-specific cerebral atrophy in 800/11810, vessel tortuosity in 128/11810 and significant carotid or vertebrobasilar stenosis in 1292/11810 of cases. On neuroimaging revision, one or more HTN features were found in 10311/11810 cases. In group 2 mean systolic BP on admission was 193mmHg, diastolic 104mmHg, age 55 years, 15/25 had PRES, 7/25 acute on chronic hypertensive encephalopathy, 2/25 CAA and 1/25 normotensive PRES. HTN findings were reported in 22/25 cases. Results suggest an initial underestimation of HTN by both referrers and radiologists in acutely symptomatic subjects, later identified and characterised when reviewed and discussed at MDTs.

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Section: Acute On Chronic Encephalopathymentioning

confidence: 83%

Neuroimaging Findings in Symptomatic Hypertensive Encephalopathy

Bertoni

Webb

Balogun

et al. 2022

MRAJ

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“…Further, we chose to compare FDD to CAA+ cases and not AD, since those patients show pronounced CAA pathology without parenchymal plaques, similar to the pathology observed in FDD. There is increased recognition of the wide spectrum of clinical manifestations of sporadic CAA and the role it plays in age‐related cognitive impairment, both in association with and independently of AD, highlighting the importance of better understanding the molecular mechanisms that underlie it (Banerjee et al, 2017; Charidimou et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Chemical traits of cerebral amyloid angiopathy in familial British‐, Danish‐, and non‐Alzheimerʼs dementias

Michno

Koutarapu

Camacho

et al. 2022

Journal of Neurochemistry

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Familial British dementia (FBD) and familial Danish dementia (FDD) are autosomal dominant forms of dementia caused by mutations in the integral membrane protein 2B (ITM2B, also known as BRI2) gene. Secretase processing of mutant BRI2 leads to secretion and deposition of BRI2-derived amyloidogenic peptides, ABri and ADan that resemble APP/β-amyloid (Aβ) pathology, which is characteristic of Alzheimer's

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“…In particular, in the definition of a <<possible CAA>> diagnosis, we took into account the presence of at least one other CAA-related white matter lesion (CSO-PVS or WMH-MS). As suggested by the new Boston Criteria v2.0 [ 43 ], this MRI finding, together with the hemorrhagic marker of a single sICH, in the absence of any deep hemorrhagic lesions and other cause of hemorrhagic lesions, was defined as a <<probable CAA>>, improving sensitivity and providing overall superior diagnostic accuracy [ 43 ]. Numerous rectifications of misdiagnosis have been required to calculate a reliable prevalence.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Cerebral Amyloid Angiopathy on Functional Outcome of Patients Affected by Spontaneous Intracerebral Hemorrhage Discharged from Intensive Inpatient Rehabilitation: A Cohort Study

et al. 2022

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Background: Sporadic CAA is recognized as a major cause of sICH and sABI. Even if intensive rehabilitation is recommended to maximize functional recovery after sICH, no data are available on whether CAA may affect rehabilitation outcomes. In this observational prospective study, to explore the impact of CAA on rehabilitation results, functional outcomes after intensive rehabilitation have been compared between patients affected by sICH with and without a diagnosis of CAA. Methods: All adults affected by sABI due to sICH and admitted to the IRU of IRCCS-Don-Gnocchi-Foundation were consecutively enrolled for 12 months. Demographic and clinical data were recorded upon admission and discharge. Results: Among 102 sICH patients (age: 66 (IQR = 16), 53% female), 13% were diagnosed as probable/possible-CAA. TPO and functional assessment were comparable upon admission, but CAA patients were significantly older (p = 0.001). After a comparable LOS, CAA patients presented higher care burden (ERBI: p = 0.025), poorer functional recovery (FIM: p = 0.02) and lower levels of global independence (GOSE > 4: p = 0.03). In multivariate analysis, CAA was significantly correlated with a lower FIM (p = 0.019) and a lower likelihood of reaching GOS-E > 4, (p = 0.041) at discharge, independently from age. Conclusions: CAA seems to be independently associated with poorer rehabilitation outcomes, suggesting the importance of improving knowledge about CAA to better predict rehabilitation outcomes.

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The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI–neuropathology diagnostic accuracy study

Cited by 201 publications

References 41 publications

Neuroimaging Findings in Symptomatic Hypertensive Encephalopathy

Neuroimaging Findings in Symptomatic Hypertensive Encephalopathy

Chemical traits of cerebral amyloid angiopathy in familial British‐, Danish‐, and non‐Alzheimerʼs dementias

The Impact of Cerebral Amyloid Angiopathy on Functional Outcome of Patients Affected by Spontaneous Intracerebral Hemorrhage Discharged from Intensive Inpatient Rehabilitation: A Cohort Study

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