Vessel Wall Enhancement on Black-Blood MRI Predicts Acute and Future Stroke in Cerebral Amyloid Angiopathy.

Autor:	McNally JS; From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah scott.mcnally@hsc.utah.edu., Sakata A; From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah., Alexander MD; From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah., Dewitt LD; Department of Pathology (J.A.S.), University of Utah, Salt Lake City, Utah., Sonnen JA; Department of Pathology (J.A.S.), University of Utah, Salt Lake City, Utah., Menacho ST; Department of Neurosurgery (S.T.M.), University of Utah, Salt Lake City, Utah., Stoddard GJ; Department of Internal Medicine (G.J.S.), University of Utah, Salt Lake City, Utah., Kim SE; From the Department of Radiology (J.S.M., A.S., M.D.A., S.-E.K.), Utah Center for Advanced Imaging Research, Utah., de Havenon AH; Department of Neurology (L.D.D., A.H.d.H.), University of Utah, Salt Lake City, Utah.
Jazyk:	angličtina
Zdroj:	AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2021 Jun; Vol. 42 (6), pp. 1038-1045. Date of Electronic Publication: 2021 Mar 18.
DOI:	10.3174/ajnr.A7047
Abstrakt:	Background and Purpose: Cerebral amyloid angiopathy (CAA) is a known risk factor for ischemic stroke though angiographic imaging is often negative. Our goal was to determine the relationship between vessel wall enhancement (VWE) in acute and future ischemic stroke in CAA patients. Materials and Methods: This was a retrospective study of patients with new-onset neurologic symptoms undergoing 3T vessel wall MR imaging from 2015 to 2019. Vessel wall enhancement was detected on pre- and postcontrast flow-suppressed 3D T1WI. Interrater agreement was evaluated in cerebral amyloid angiopathy-positive and age-matched negative participants using a prevalence- and bias-adjusted kappa analysis. In patients with cerebral amyloid angiopathy, multivariable Poisson and Cox regression were used to determine the association of vessel wall enhancement with acute and future ischemic stroke, respectively, using backward elimination of confounders to P < .20. Results: Fifty patients with cerebral amyloid angiopathy underwent vessel wall MR imaging, including 35/50 (70.0%) with ischemic stroke and 29/50 (58.0%) with vessel wall enhancement. Prevalence- and bias-corrected kappa was 0.82 (95% CI, 0.71-0.93). The final regression model for acute ischemic stroke included vessel wall enhancement (prevalence ratio = 1.5; 95% CI, 1.1-2.2; P = .022), age (prevalence ratio = 1.02; 95% CI, 1.0-1.05; P = .036), time between symptoms and MR imaging (prevalence ratio = 0.9; 95% CI, 0.8-0.9; P < .001), and smoking (prevalence ratio = 0.7; 95% CI, 0.5-1.0; P = .042) with c-statistic = 0.92 (95% CI, 0.84-0.99). Future ischemic stroke incidence with cerebral amyloid angiopathy was 49.7% (95% CI, 34.5%-67.2%) per year over a total time at risk of 37.5 person-years. Vessel wall enhancement-positive patients with cerebral amyloid angiopathy demonstrated significantly shorter stroke-free survival with 63.9% (95% CI, 43.2%-84.0%) versus 32.2% (95% CI, 14.4%-62.3%) ischemic strokes per year, chi-square = 4.9, P = .027. The final model for future ischemic stroke had a c-statistic of 0.70 and included initial ischemic stroke (hazard ratio = 3.4; 95% CI, 1.0-12.0; P = .053) and vessel wall enhancement (hazard ratio = 2.5; 95% CI, 0.9-7.0; P = .080). Conclusions: Vessel wall enhancement is associated with both acute and future stroke in patients with cerebral amyloid angiopathy. (© 2021 by American Journal of Neuroradiology.)
Databáze:	MEDLINE
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