Diagnostic accuracy of cerebral amyloid angiopathy criteria in the first pathologically confirmed Thai cohort: A pilot study

Thanapoom  Taweephol; Thachamai  Smitasiri; Thanakit  Pongpitakmetha; Sekh  Thanprasertsuk; Anand  Viswanathan

Authors

Thanapoom Taweephol Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
Thachamai Smitasiri Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Cognitive, Clinical and Computational Neuroscience (CCCN) Center of Excellence, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Thanakit Pongpitakmetha Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand and Comprehensive Headache and Orofacial Pain (CHOP) research group and service, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Sekh Thanprasertsuk Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Cognitive, Clinical and Computational Neuroscience (CCCN) Center of Excellence, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand andComprehensive Headache and Orofacial Pain (CHOP) research group and service, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Anand Viswanathan J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Keywords:

Cerebral amyloid angiopathy, diagnostic criteria, neuroimaging, neuropathology

Abstract

Background: The gold standard for diagnosing cerebral amyloid angiopathy (CAA) is full brain postmortem examination, which is rarely performed. Current diagnostic criteria are primarily based on clinical-radiological features and were developed from Western populations and thus may have limited applicability to Asian populations.

Objectives: We aimed to evaluate the accuracy of current diagnostic criteria and examine the clinicalradiological characteristics of Thai patients with CAA.

Methods: Brain histopathological specimens were reviewed from patients with clinical symptoms of CAA who underwent neurosurgical procedures, including intracerebral hemorrhage (ICH) evacuation, between 2011 and 2021 at King Chulalongkorn Memorial Hospital, Thai Red Cross Society. Patient characteristics and clinical events were collected retrospectively. Trained investigators systematically rated the radiological biomarkers from brain imaging performed closest to the date of pathological confirmation. The diagnostic accuracies of the Modified Boston Criteria v1.5, Boston Criteria v2.0, and Simplified Edinburgh Criteria were compared.

Results: Thirty-five pathological reports were reviewed. Eight patients (median age of 76.7 years) with confirmed CAA had 11 clinical events, including weakness, altered consciousness, headache, seizures, and aphasia. Receiver operating characteristic curve analysis revealed that the Boston Criteria v2.0 had higher sensitivity compared to the Modified Boston Criteria v1.5. Moreover, the Simplified Edinburgh Criteria demonstrated lower sensitivity compared to both of the Boston Criteria. The area under the curve for probable CAA using the Modified Boston Criteria v1.5 was 0.9 (95% confidence interval 0.8–1.0).

Conclusion: This pilot study reveals the diagnostic performance of CAA criteria and demonstrates its applicability among the Asian population. In resource-limited settings, the simplified Edinburgh criteria, which are computerized tomography-based criteria, are valuable for diagnosing patients with CAA-ICH. This is a pilot study with a relatively small sample size; larger studies with Asian cohorts are warranted to further validate these findings.

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