Distribution of Lacunar Infarcts in Asians With Intracerebral Hemorrhage: A Magnetic Resonance Imaging and Amyloid Positron Emission Tomography Study

Abstract

Background and purpose: We evaluated whether lacunes in centrum semiovale (lobar lacunes) were associated with cerebral amyloid angiopathy (CAA) markers in an Asian intracerebral hemorrhage (ICH) population.

Methods: One hundred ten patients with primary ICH were classified as CAA-ICH (n=24; mean age, 70.9±13.9) or hypertensive ICH (n=86; mean age, 59.3±13.0) according to the presence of strictly lobar (per modified Boston criteria) or strictly deep bleeds (both ICH and cerebral microbleeds), respectively. Lacunes were evaluated in the supratentorial area and classified as lobar or classical deep based on the location. A subgroup of 36 patients also underwent Pittsburgh Compound B positron emission tomography to measure cerebral amyloid deposition and global standardized uptake value ratio were calculated.

Results: Lobar lacunes were more frequent in CAA-ICH than hypertensive ICH (29.2 versus 11.6%; P=0.036). In multivariable models, lobar lacunes were associated with lobar cerebral microbleed (odds ratio, 6.8; 95% confidence interval, 1.6-29.9; P=0.011) after adjustment for age, sex, hypertension, and white matter hyperintensity. In 15 CAA-ICH and 21 hypertensive ICH patients with Pittsburgh Compound B positron emission tomography, correlation analyses between lobar lacune counts and global standardized uptake value ratio showed positive association (ρ=0.40; P=0.02) and remained significant after adjustment for age (r=0.34; P=0.04).

Conclusions: Our findings expand on recent work showing that lobar lacunes are more frequent in CAA-ICH than hypertensive ICH. Their independent association with lobar cerebral microbleeds and brain amyloid deposition suggests a relationship with CAA even in an Asian cohort with overall higher hypertensive load.

Keywords: cerebral amyloid angiopathy; cerebral hemorrhage; cerebral small vessel diseases; hypertension.

© 2018 American Heart Association, Inc.

Figures

Figure 1. Figure representatives of lacune location and amyloid scan findings

(A and B) Patient with CAA-ICH. (A) SWI showed left frontal ICH and numerous microbleeds restricted to lobar regions. Fluid-attenuated MRI sequence showing a lobar lacune (arrow). (B) PiB PET showed increased cortical amyloid retention (SUVR=1.43). (C and D) Patient with HTN-ICH. (C) SWI showed a left putaminal ICH without additional microbleed. Fluid-attenuated MRI sequence showed one deep lacune in the basal ganglia (arrow) (D) PiB PET showed absence cortical amyloid retention (SUVR=1.01).