New diagnostic criteria developed by the University of Edinburgh, have demonstrated an excellent ability to identify cerebral amyloid angiopathy (CAA)-associated lobar intracerebral haemorrhage (ICH).
Using data from participants of the prospective, population-based Lothian IntraCerebral Haemorrhage, Pathology, Imaging and Neurological Outcome (LINCHPIN) study, a team led by the Centre for Clinical Brain Sciences at the University of Edinburgh identified 110 adults who had experience a first-ever and fatal ICH, diagnosed on CT. Research autopsies were carried out.
It was found that 56% of the ICHs were lobar, 37% were deep and 6% were infratentorial. Of the 62 patients with lobar ICH, 58% were associated with moderate or severe CAA compared with 42% that were associated with absent or mild CAA. In multivariable analyses, participants with lobar ICH and moderate-severe CAA were significantly more likely to be APOE ɛ4 carriers and to have a strictly lobar ICH, subarachnoid haemorrhage, and finger-like projections from the ICH compared with participants with lobar ICH and absent or mild CAA.
A prediction model for CAA-associated lobar ICH using these 3 variables had excellent discrimination ability (c statistic, 0.92; 95% CI, 0.86-0.98). For the rule-out criteria, neither subarachnoid haemorrhage nor APOE ɛ4 had 100% (95% CI, 88%-100%) sensitivity. For the rule-in criteria, subarachnoid haemorrhage and either APOE ɛ4 possession or finger-like projections had 96% (95% CI, 78%-100%) specificity.
Presenting the findings in Lancet Neurology, the authors say the criteria require external validation, but the Edinburgh rule-in and rule-out diagnostic criteria might inform prognostic and therapeutic decisions that depend on the identification of CAA-associated lobar ICH.