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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Y. Inoue</span>, <span class="highwire-citation-author" data-delta="1">M. Nakajima</span>, <span class="highwire-citation-author" data-delta="2">T. Hirai</span> and <span class="highwire-citation-author" data-delta="3">Y. Ando</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2016,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">37 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E26; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4686 </span></div>
  
  
  
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<div id="hw-article-author-popups-node-14321--275284205" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Y. Inoue </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Neurology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BInoue%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Inoue%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AY.%2BInoue%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M. Nakajima </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Neurology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BNakajima%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nakajima%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.%2BNakajima%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">T. Hirai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Diagnostic Radiology</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BHirai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hirai%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AT.%2BHirai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Y. Ando </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Neurology
Graduate School of Medical Sciences
Kumamoto University
Kumamoto, Japan</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BAndo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ando%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AY.%2BAndo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We sincerely thank Harrison X. Bai and colleagues for their interest and comments regarding our recent article, in which we demonstrated the diagnostic significance of cortical superficial siderosis (cSS) for Alzheimer disease in patients with cognitive impairment.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup></p><p id="p-2">Regarding the methodologic issues of the present study that their letter raises, the diagnosis of cSS seen on susceptibility-weighted imaging was based on collegial discussion with experienced neuroradiologists, and no data are available for interobserver variability. We defined cSS as linear hypointensities on the surface of the cerebral gyri on SWI. The appearance of cSS on SWI was obvious in this study; fortunately, we had no difficulty in distinguishing cSS from lobar cerebral microbleeds (MBs). Very superficial clusters of multiple MBs can be mistaken for cSS, but these would be distinguished by their irregular appearance.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup></p><p id="p-3">In relation to exclusions, 4 patients with previous symptomatic subarachnoid hemorrhage, 23 patients with traumatic subdural hematoma, and 1 patient with an intracranial operation were excluded according to medical charts. We therefore presented 12 cases with cSS that did not seem to have occult sources of bleeding, as the authors pointed out.</p><p id="p-4">We agree with their statement that elucidating the pathogenesis of cSS from cerebral amyloid angiopathy (CAA) warrants further analysis. However, imaging-histopathologic correlations shown in cases with CAA might indicate that recurrent blood leakage of meningeal vessels leads to the propagation of cSS.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> To confirm the progression of CAA-related cSS, prospective studies are needed that recruit patients with CAA based on the Boston criteria.<sup><a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup></p><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><div class="cit ref-cit ref-journal" id="cit-37.3.E26.1" data-doi="10.3174/ajnr.A4496"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Inoue</span>  <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Nakajima</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Uetani</span>  <span class="cit-name-given-names">H</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Diagnostic significance of cortical superficial siderosis for Alzheimer disease in patients with cognitive impairment</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2015</span> 
<span class="cit-month">Oct</span> 
<span class="cit-day">8</span>. <span class="cit-comment">[Epub ahead of print]</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A4496</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26450535</span></cite></div></div></li><li><span class="ref-label">2.</span><div class="cit ref-cit ref-journal" id="cit-37.3.E26.2" data-doi="10.1093/brain/awv162"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Charidimou</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Linn</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Vernooij</span>  <span class="cit-name-given-names">MW</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Cortical superficial siderosis: detection and clinical significance in cerebral amyloid angiopathy and related conditions</span>. <abbr class="cit-jnl-abbrev">Brain</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">138</span>:<span class="cit-fpage">2126</span>–<span class="cit-lpage">39</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1093/brain/awv162</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>26115675</span></cite></div></div></li><li><span class="ref-label">3.</span><div class="cit ref-cit ref-journal" id="cit-37.3.E26.3" data-doi="10.1161/STROKEAHA.115.008778"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Beitzke</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Enzinger</span>  <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Wünsch</span>  <span class="cit-name-given-names">G</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Contribution of convexal subarachnoid hemorrhage to disease progression in cerebral amyloid angiopathy</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">46</span>:<span class="cit-fpage">1533</span>–<span class="cit-lpage">40</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1161/STROKEAHA.115.008778</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>25953372</span></cite></div></div></li><li><span class="ref-label">4.</span><div class="cit ref-cit ref-journal" id="cit-37.3.E26.4" data-doi="10.1212/WNL.56.4.537"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Knudsen</span>  <span class="cit-name-given-names">KA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Rosand</span>  <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Karluk</span>  <span class="cit-name-given-names">D</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria</span>. <abbr class="cit-jnl-abbrev">Neurology</abbr> <span class="cit-pub-date">2001</span>;<span class="cit-vol">56</span>:<span class="cit-fpage">537</span>–<span class="cit-lpage">39</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1212/WNL.56.4.537</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>11222803</span></cite></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2016 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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