Abstract WP214: Cortical Microinfarcts as a Putative MRI Marker for Cerebral Amyloid Angiopathy

Abstract

Background: Cortical microinfarcts (CMIs) are frequently detected in autopsy brains of elderly subjects, and distributed predominantly in the area of predilection for cerebral amyloid angiopathy (CAA). Recently these lesions have been detected on high-filed MRI using double inversion recovery (DIR) and 3D-fluid attenuated inversion recovery (FLAIR). Radiological diagnosis according to Boston criteria for CAA may be reinforced by detecting CMIs. Methods: We performed a prospective analysis of 36 patients diagnosed as clinically probable CAA by Boston criteria, including multiple strictly lobar microbleeds as a diagnostic indicator. These patients were recruited at the Department of Neurology, Mie University Hospital from August 2009 to April 2012. 3-tesla MR images including susceptibility-weighted imaging (SWI), DIR and 3D- FLAIR were reviewed. Results: CMIs were found in 9 of 36 (25%) patients. Most CMIs were located in close proximity to lobar microbleeds. Cortical superficial siderosis was observed in 6 of 36 (16.6%) patients, among which 5 (83.3%) showed CMIs. There were 5 patients with symptomatic subcortical hemorrhage, and 3 of these (60%) showed both CMIs and superficial siderosis. Conclusions: These results indicate that CMIs strengthen radiological diagnosis of CAA if these lesions coexist with multiple strictly lobar microbleeds and cortical superficial siderosis.