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2017 ; 12
(7
): e0180923
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Imaging features of intracerebral hemorrhage with cerebral amyloid angiopathy:
Systematic review and meta-analysis
#MMPMID28700676
Samarasekera N
; Rodrigues MA
; Toh PS
; Al-Shahi R
PLoS One
2017[]; 12
(7
): e0180923
PMID28700676
show ga
BACKGROUND: We sought to summarize Computed Tomography (CT)/Magnetic Resonance
Imaging (MRI) features of intracerebral hemorrhage (ICH) associated with cerebral
amyloid angiopathy (CAA) in published observational radio-pathological studies.
METHODS: In November 2016, two authors searched OVID Medline (1946-), Embase
(1974-) and relevant bibliographies for studies of imaging features of lobar or
cerebellar ICH with pathologically proven CAA ("CAA-associated ICH"). Two authors
assessed studies' diagnostic test accuracy methodology and independently
extracted data. RESULTS: We identified 22 studies (21 cases series and one
cross-sectional study with controls) of CT features in 297 adults, two
cross-sectional studies of MRI features in 81 adults and one study which reported
both CT and MRI features in 22 adults. Methods of CAA assessment varied, and
rating of imaging features was not masked to pathology. The most frequently
reported CT features of CAA-associated ICH in 21 case series were: subarachnoid
extension (pooled proportion 82%, 95% CI 69-93%, I2 = 51%, 12 studies) and an
irregular ICH border (64%, 95% CI 32-91%, I2 = 85%, five studies). CAA-associated
ICH was more likely to be multiple on CT than non-CAA ICH in one cross-sectional
study (CAA-associated ICH 7/41 vs. non-CAA ICH 0/42; ?2 = 7.8, p = 0.005).
Superficial siderosis on MRI was present in 52% of CAA-associated ICH (95% CI
39-65%, I2 = 35%, 3 studies). CONCLUSIONS: Subarachnoid extension and an
irregular ICH border are common imaging features of CAA-associated ICH, but
methodologically rigorous diagnostic test accuracy studies are required to
determine the sensitivity and specificity of these features.