Abstract TP340: Centrum-semiovale Enlarged Perivascular Space and Amyloid Deposition in Primary Intracerebral Hemorrhage

Abstract

Background: Higher load of MRI visible enlarged perivascular spaces in centrum-semiovale (CSO-EPVS) are found in cerebral amyloid angiopathy (CAA), but their association to brain amyloid has been rarely investigated, especially in Asians. We explored whether high degree of CSO-EPVS is associated to other MRI signatures of CAA and its relationship to brain amyloid retention in patients with primary intracerebral hemorrhage (ICH). Methods: 110 patients with either CAA-ICH, strictly lobar ICH and microbleeds (MB) or hypertensive ICH (HTN-ICH), strictly deep-seated ICH/MBs, were included in this study. CSO-EPVS and basal ganglia EPVS (BG-EPVS) were assesd using an established 4-point semiquantitative score. EPVS degree was classified as high (score>2) or low (≤2). We also evaluated MBs, cortical superficial siderosis (cSS), white matter hyperintensities (WMH) and brain atrophy severity on MRIs. Cerebral amyloid deposition was quantified on 11 C-Pittsburgh Compound B (PiB) PETs in 36 patients (15 CAA; 21 HA) as standardized uptake value ratio (SUVR). Results: Patients with CAA-related ICH (n=24) and HTN-ICH (n=86) had similar prevalence of high-degree CSO-EPVS (37.5% and 26.7%, p=0.305) and high-degree BG-EPVS (25% and 18.6%, p=0.489). Patients with high-degree CSO-EPVS were associated with presence of lobar MB (p=0.01) and higher WMH (p=0.008), while patients with high-degree EPVS-BG were associated with older age (p=0.002), higher WMH (p=0.021) and more cortical atrophy (p=0.023). The amyloid burden (global SUVR) was higher in high-degree vs low-degree EPVS-CSO in CAA-ICH (p=0.045), but not in HTN-ICH (p=0.586). On multivariate logistic regression analysis, the degree of EPVS-CSO remains an independent indicator for positive amyloid scan (defined as global SUVR>1.2) even after adjustment for age, WMH, the degree of EPVS-BG and ICH/MBs distribution (Odds ratio 6.2 [1.2-31.6], p=0.029). Conclusion: Although the presence of EPVS-CSO could not directly distinguish CAA-ICH and HTN-ICH in our Asian cohort, high-degree EPVS-CSO was associated with CAA-related MRI markers such as lobar MBs, and higher amyloid load on PiB-PET. The burden of CSO-EPVS can be seen as an indicator of higher brain amyloid deposition in patients with CAA-related ICH.