Magnetic resonance imaging-based scores of small vessel diseases: Associations with intracerebral haemorrhage location

Ghil Schwarz,Gargi Banerjee,Isabel Charlotte Hostettler,Gareth Ambler,David J Seiffge,Tenzin S Brookes,Duncan Wilson,Hannah Cohen,Tarek Yousry,Rustam Al-Shahi Salman,Gregory Y.H Lip,Martin M Brown,Keith W Muir,Henry Houlden,Rolf Jäger,David J Werring,Julie Staals

doi:10.1016/j.jns.2022.120165

Abstract

IntroductionTotal small vessel disease (SVD) score and cerebral amyloid angiopathy (CAA) score are magnetic resonance imaging-based composite scores built to preferentially capture deep perforator arteriopathy-related and CAA-related SVD burden, respectively. Non-lobar intracerebral haemorrhage (ICH) is related to deep perforator arteriopathy, while lobar ICH can be associated with deep perforator arteriopathy or CAA; however, the associations between ICH location and these scores are not established. MethodsIn this post-hoc analysis from a prospective cohort study, we included 153 spontaneous non-cerebellar ICH patients. Wald test, univariable and multivariable logistic regression analysis were performed to investigate the association between each score (and individual score components) and ICH location. ResultsTotal SVD score was associated with non-lobar ICH location (Wald test: unadjusted, p = 0.017; adjusted, p = 0.003); however, no individual component of total SVD score was significantly associated with non-lobar ICH. CAA score was not significantly associated with lobar location (Wald test: unadjusted, p = 0.056; adjusted, p = 0.126); cortical superficial siderosis (OR 8.85 [95%CI 1.23–63.65], p = 0.030) and ≥ 2 strictly lobar microbleeds (OR 1.63 [95%CI 1.04–2.55], p = 0.035) were related with lobar ICH location, while white matter hyperintensities showed an inverse relation (OR 0.53 [95%CI 0.26–1.08; p = 0.081]). ConclusionsTotal SVD score was associated with non-lobar ICH location. The lack of significant association between CAA score and lobar ICH may in part be due to the mixed aetiology of lobar ICH, and to the inclusion of white matter hyperintensities, a non-specific marker of SVD type, in the CAA score.

Highlights

Total small vessel disease (SVD) score and cerebral amyloid angiopathy (CAA) score are magnetic resonance imaging-based composite scores built to preferentially capture deep perforator arteriopathy-related and CAA-related SVD burden, respectively
Total SVD scores were higher in patients with non-lobar vs lobar intracerebral haemorrhage (ICH) location, while CAA scores were higher in patients with lobar vs nonlobar ICH location
Our findings suggest that the inclusion of white matter hyperintensities, a non-specific marker of SVD type, in CAA score may partially explain the non-significant association between the score and lobar ICH

Summary

Introduction

Total small vessel disease (SVD) score and cerebral amyloid angiopathy (CAA) score are magnetic resonance imaging-based composite scores built to preferentially capture deep perforator arteriopathy-related and CAA-related SVD burden, respectively. CAA score was not significantly associated with lobar location (Wald test: unadjusted, p=0.056; adjusted, p=0.126); cortical superficial siderosis (OR 8.85 [95%CI 1.23-63.65], p=0.030) and ≥2 strictly lobar microbleeds (OR 1.63 [95%CI 1.04-2.55], p=0.035) were related with lobar ICH location, while white matter hyperintensities showed an inverse relation (OR 0.53 [95%CI 0.26-1.08; p=0.081]). Most spontaneous (non-traumatic) intracerebral haemorrhages (ICH) are caused by disease of the small vessels in the brain.[1, 2] Deep perforator arteriopathy and cerebral amyloid angiopathy (CAA) are the two most common types of small vessel disease (SVD) underlying ICH [3]. The CAA score measures strictly lobar microbleeds, cortical superficial siderosis, centrum semiovale perivascular spaces and white matter hyperintensities with the aim of capturing the burden of CAA [7]

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