Zerebrale Amyloidangiopathie und ihre Folgen

Die zerebrale Amyloidangiopathie (CAA) ist charakterisiert durch Amyloidablagerungen in kleinen kortikalen und leptomeningealen Gefäßen, wobei die Boston-Kriterien die Diagnosestellung einer wahrscheinlichen CAA ermöglichen. Bei der CAA-assoziierten Inflammation treten amyloidbedingte bildmorphologische Auffälligkeiten auf, bei denen ein ödematöser und ein hämorrhagischer Subtyp in der MRT unterschieden werden können.

Abstract

Cerebral amyloid angiopathy (CAA) is characterized by the deposition of amyloid in the vessel walls of small cortical and leptomeningeal arteries. Whereas the definite diagnosis requires a brain biopsy, knowledge of clinical and neuroimaging findings in CAA is essential. The Boston criteria version 2.0 including characteristic clinical and neuroradiological features facilitates the diagnosis of probable CAA. Spontaneous and amyloid-beta immunotherapy-associated CAA-related inflammation cause amyloid related imaging abnormalities (ARIA). There are two subtypes: ARIA-E (edema, leptomeningeal effusion) and ARIA-H (haemorrhagic).

Schlüsselwörter

zerebrale Amyloidangiopathie (CAA) - Boston-Kriterien - amyloidbedingte bildmorphologische Auffälligkeiten (ARIA)

Keywords

cerebral amyloid angiopathy (CAA) - Boston criteria - amyloid related imaging abnormalities (ARIA)

• Literatur

• 1 Charidimou A, Gang Q, Werring DJ. Sporadic cerebral amyloid angiopathy revis-ited: recent insights into pathophysiology and clinical spectrum. J Neurol Neurosurg Psychiatry 2012; 83: 124-137
• 2 Greenberg SM, Vonsattel JP, Stakes JW. et al. The clinical spectrum of cerebral amyloid angiopathy: presentations without lobar hemorrhage. Neurology 1993; 43: 2073-2079
• 3 Greenberg SM, Bacskai BJ, Hernandez-Guillamon M. et al. Cerebral amyloid angiopathy and Alzheimer disease—one peptide, two pathways. Nat Rev Neurol 2020; 16: 30-42
• 4 Weller RO, Subash M, Preston SD. et al. Perivascular drainage of amyloid-beta peptides from the brain and its failure in cerebral amyloid angiopathy and Alzheimer’s disease. Brain Pathol 2008; 18: 253-266
• 5 Weller RO, Hawkes CA, Kalaria RN. et al. White Matter Changes in Dementia: Role of Impaired Drainage of Interstitial Fluid. Brain Pathol 2015; 25: 63-78
• 6 Benveniste H, Liu X, Koundal S. et al. The Glymphatic System and Waste Clearance with Brain Aging: A Review. Gerontology 2019; 65: 106-119
• 7 Cozza M, Amadori L, Boccardi V. Exploring cerebral amyloid angiopathy: Insights into pathogenesis, diagnosis, and treatment. J Neurol Sci 2023; 454: 120866
• 8 Jäkel L, De Kort AM, Klijn CJM. et al. Prevalence of cerebral amyloid angiopathy: A systematic review and meta-analysis. Alzheimers Dement 2022; 18: 10-28
• 9 Charidimou A. Cerebral amyloid angiopathy-related transient focal neurological episodes (CAA-TFNEs): A well-defined clinical-radiological syndrome. J Neurol Sci 2019; 406: 116496
• 10 Weidauer S, Tafreshi M, Foerch C. et al. Clinical and neuroimaging precursors in cerebral amyloid angiopathy: Impact of the Boston criteria version 2.0. Eur J Neurol 2024; 10: e16425
• 11 Charidimou A, Boulouis G, Frosch MP. et al. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol 2022; 21: 714-725
• 12 Greenberg SM, Vernooij MW, Cordonnier C. Microbleed Study Group. et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol 2009; 8: 165-174
• 13 Haller S, Vernooij MW, Kuijer JPA. et al. Cerebral microbleeds: imaging and clinical significance. Radiology 2018; 287: 11-28
• 14 Wardlaw JM, Smith EE, Biessels GJ. STandards for ReportIng Vascular changes on nEuroimaging (STRIVE v1). et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12: 822-838
• 15 Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9: 689-701
• 16 Weidauer S, Wagner M, Hattingen E. White Matter Lesions in Adults – a Differential Diagnostic Approach. Rofo 2020; 192: 1154-1173
• 17 Greenberg SM, Charidimou A. Diagnosis of cerebral amyloid angiopathy: evolution of the Boston criteria. Stroke 2018; 49: 491-497
• 18 Linn J. Zerebrale Mikroblutungen: Bildgebung, Ursachen und Differenzialdiagnosen. Radiologie up2date 2016; 16: 279-292
• 19 Charidimou A, Boulouis G, Fotiadis P. et al. Acute convexity subarachnoid haemorrhage and cortical superficial siderosis in probable cerebral amyloid angiopathy without lobar haemorrhage. J Neurol Neurosurg Psychiatry 2018; 89: 397-403
• 20 Charidimou A, Linn J, Vernooij MW. et al. Cortical superficial siderosis: detection and clinical significance in cerebral amyloid angiopathy and related conditions. Brain 2015; 138: 2126-2139
• 21 Kumar N. Superficial Siderosis: A clinical review. Ann Neurol 2021; 89: 1068-1079
• 22 Weidauer S, Neuhaus E, Hattingen E. Cerebral Superficial Siderosis: Etiology, Neuroradiological Features and Clinical Findings. Clin Neuroradiol 2023; 33: 293-306
• 23 Linn J, Halpin A, Demaerel P. et al. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Neurology 2010; 74: 1346-1350
• 24 Linn J, Michl S, Katja B. et al. Cortical vein thrombosis: the diagnostic value of different imaging modalities. Neuroradiology 2010; 52: 899-911
• 25 Charidimou A, Boulouis G, Pasi M. et al. MRI-visible perivascular spaces in cerebral amyloid angiopathy and hypertensive arteriopathy. Neurology 2017; 88: 1157-1164
• 26 Charidimou A, Boulouis G, Haley K. et al. White matter hyperintensity patterns in cerebral amyloid angiopathy and hypertensive arteriopathy. Neurology 2016; 86: 505-511
• 27 Knudsen KA, Rosand J, Karluk D. et al. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology 2001; 56: 537-539
• 28 Caetano A, Ladeira F, Barbosa R. et al. Cerebral amyloid angiopathy – The modified Boston criteria in clinical practice. J Neurol Sci 2018; 384: 55-57
• 29 Charidimou A, Boulouis G. Clinical Diagnosis of Probable Cerebral Amyloid Angiopathy: Diagnostic Accuracy Meta-Analysis of the Boston Criteria. Stroke 2022; 53: 3679-3687
• 30 Stehling C, Wersching H, Kloska SP. et al. Detection of asymptomatic cerebral microbleeds: a comparative study at 1.5 and 3.0 T. Acad Radiol 2008; 15: 895-900
• 31 Cheng AL, Batool S, McCreary CR. et al. Susceptibility-weighted imaging is more reliable than T2*- weighted gradient-recalled echo MRI for detecting microbleeds. Stroke 2013; 44: 2782-2786
• 32 Salvarani C, Hunder GG, Morris JM. et al. Aβ-related angiitis: comparison with CAA without inflammation and primary CNS vasculitis. Neurology 2013; 81: 1596-1603
• 33 Auriel E, Charidimou A, Gurol ME. et al. Validation of clinicoradiological criteria for the diagnosis of cerebral amyloid angiopathy-related inflammation. JAMA Neurol 2016; 73: 197-202
• 34 Antolini L, Di Francesco JC, Zedde M. et al. Spontaneous ARIA-like Events in Cerebral Amyloid Angiopathy-Related Inflammation: A Multicenter Prospective Longitudinal Cohort Study. Neurology 2021; 97: e1809-e1822
• 35 Coulette S, Renard D, Lehmann S. et al. A clinico-radiological study of cerebral amyloid angiopathy–related inflammation. Cerebrovasc Dis 2019; 48: 38-44
• 36 Barakos J, Sperling R, Salloway S. et al. MR imaging features of amyloid-related imaging abnormalities. AJNR Am J Neuroradiol 2013; 34: 1958-1965
• 37 Barkhof F, Daams M, Scheltens P. et al. An MRI Rating Scale for Amyloid-Related Imaging Abnormalities with Edema or Effusion. AJNR Am J Neuroradiol 2013; 34: 1550-1555
• 38 Urbach H, Linn J, Hattingen E. et al. Imaging of Amyloid-Related Imaging Abnormalities (ARIA). Rofo 2024; 196: 363-369
• 39 Schaumberg J, Trauscheid M, Eckert B. et al. Cerebral amyloid angiopathy associated with inflammation. Nervenarzt 2018; 89: 682-691
• 40 Scolding NJ, Joseph F, Kirby PA. et al. Aβ-related angiitis: primary angiitis of the central nervous system associated with cerebral amyloid angiopathy. Brain 2005; 128: 500-515
• 41 Berlit P. Diagnosis and treatment of cerebral vasculitis. Ther Adv Neurol Disord 2010; 3: 29-42
• 42 Sakai K, Boche D, Carare R. et al. Aβ immunotherapy for Alzheimer’s disease: effects on apoE and cerebral vasculopathy. Acta Neuropathol 2014; 128: 777-789
• 43 Salloway S, Chalkias S, Barkhof F. et al. Amyloid-Related Imaging Abnormalities in 2 Phase 3 Studies Evaluating Aducanumab in Patients With Early Alzheimer Disease. JAMA Neurol 2022; 79: 13-21
• 44 Klein G, Scelsi MA, Barakos J. et al. Comparing ARIA-E severity scales and effects of treatment management thresholds. Alzheimers Dement (Amst) 2022; 14: e12376