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RT Journal Article
SR Electronic
T1 Occult Amyloid-β-Related Angiitis: Neuroimaging Findings at 1.5T, 3T, and 7T MRI
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1013
OP 1018
DO 10.3174/ajnr.A8264
VO 45
IS 8
A1 Özütemiz, Can
A1 Hussein, Haitham M.
A1 Ikramuddin, Salman
A1 Clark, H. Brent
A1 Charidimou, Andreas
A1 Streib, Christopher
YR 2024
UL http://www.ajnr.org/content/45/8/1013.abstract
AB Cerebral amyloid angiopathy (CAA) is a progressive neurodegenerative small vessel disease that is associated with intracranial hemorrhage and cognitive impairment in the elderly. The clinical and radiographic presentations have many overlapping features with vascular cognitive impairment, hemorrhagic stroke, and Alzheimer disease (AD). Amyloid-β-related angiitis (ABRA) is a form of primary CNS vasculitis linked to CAA, with the development of spontaneous autoimmune inflammation against amyloid in the vessel wall with resultant vasculitis. The diagnosis of ABRA and CAA is important. ABRA is often fatal if untreated and requires prompt immunosuppression. Important medical therapies such as anticoagulation and antiamyloid agents for AD are contraindicated in CAA. Here, we present a biopsy-proved case of ABRA with underlying occult CAA. Initial 1.5T and 3T MR imaging did not suggest CAA per the Boston Criteria 2.0. ABRA was not included in the differential diagnosis due to the lack of any CAA-related findings on conventional MR imaging. However, a follow-up 7T MR imaging revealed extensive cortical/subcortical cerebral microbleeds, cortical superficial siderosis, and intragyral hemorrhage in extensive detail throughout the supratentorial brain regions, which radiologically supported the diagnosis of ABRA in the setting of CAA. This case suggests an increased utility of high-field MR imaging to detect occult hemorrhagic neuroimaging findings with the potential to both diagnose more patients with CAA and diagnose them earlier.ABRAamyloid-β-related angiitisADAlzheimer diseaseCAAcerebral amyloid angiopathyCSScortical superficial siderosisPCRpolymerase chain reactionPiB-PETPittsburgh compound-BSPACEsampling perfection with application-optimized contrasts by using different flip angle evolutionGREgradient-echo