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

Authors

Thanapoom Taweephol, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandFollow
Thachamai Smitasiri, Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandFollow
Thanakit Pongpitakmetha, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandFollow
Sekh Thanprasertsuk, Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandFollow
Anand Viswanathan, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USAFollow

Abstract

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

Objective: We aimed to evaluate the accuracy of current diagnostic criteria and examine the clinico-radiological characteristics of Thai CAA patients.

Methods: Brain histopathological specimens 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, Thailand, were reviewed. Patient characteristics and clinical events for each individual were retrospectively collected. Trained investigators systematically rated radiological biomarkers from brain imaging performed closest to the pathological confirmation date. 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: 76.7 years) with confirmed CAA had 11 clinical events, including weakness, altered consciousness, headache, seizures, and aphasia. Receiver operating characteristic curve analysis showed that the Boston Criteria v2.0 had higher sensitivity compared to the Modified Boston Criteria v1.5. In contrast, the Simplified Edinburgh Criteria demonstrated lower sensitivity compared to the Boston Criteria. The area under the curve for probable CAA using the Modified Boston Criteria v1.5 was 0.93 (95% confidence interval: 0.76–1.00).

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

DOI

10.56808/2673-060X.5589

Recommended Citation

Taweephol, Thanapoom; Smitasiri, Thachamai; Pongpitakmetha, Thanakit; Thanprasertsuk, Sekh; and Viswanathan, Anand () "Diagnostic accuracy of cerebral amyloid angiopathy criteria in the first pathologically confirmed Thai cohort: A pilot study," Chulalongkorn Medical Journal: Vol. 70: Iss. 1, Article 3.
DOI: https://doi.org/10.56808/2673-060X.5589
Available at: https://digital.car.chula.ac.th/clmjournal/vol70/iss1/3