Available online 6 December 2023

Author links open overlay panel, , , , , , AbstractMaterials and methods

Neuroimaging data gathered from a prospective cohort of CAA patients with probable or definite CAA were retrospectively analyzed by two independent raters. SWI and GRE-T2* were used to assess presence and severity (absent, focal [≤ 3 sulci] or disseminated [> 3 sulci]) of cSS and number of foci. Ratings were compared between sequences and inter-rater agreement was determined. Post hoc analysis explored differences in cSS multifocality scores.

Results

We detected cSS in 38 patients with SWI and in 36 with GRE-T2* (70.4% versus 66.7%; P = 0.5). The two raters agreed in detecting more disseminated cSS when using SWI: 16 focal (29.63%) and 20 disseminated (37.04%) cases of cSS seen on GRE-T2* and 11 (20.37%) focal and 27 (50%) disseminated cSS cases seen using SWI (P = 0.008). Inter-rater agreement was equivalent for the two sequences (κpresence 0.7 versus 0.69; κseverity 0.74 versus 0.66) for assessing both presence and severity of cSS. Post hoc analysis showed higher multifocality scores from both raters’ SWI evaluations, with agreement equivalent to that for T2* evaluations.

Conclusions

Our findings suggest that SWI ratings could show more disseminated cSS and higher multifocality scores in advanced CAA patients with inter-rater reliability equivalent to that obtained using GRE-T2*, regardless of level of experience.

Section snippetsAbbreviationsBCv2.0

Boston criteria version 2

CAA

cerebral amyloid angiopathy

CMB

cerebral microbleeds

cSAH

cortical subarachnoid arachnoid hemorrhage

cSS

cortical superficial siderosis

cSVD

cerebral small-vessel disease

FLAIR

fluid attenuated inversion recovery

GRE-T2*

gradient recalled echo-T2*

ICC

intraclass correlation coefficient

lICH

lobar intra-cerebral hemorrhages

mBC

modified Boston criteria

R1

Rater 1

R2

Rater 2

Participants

Imaging was obtained from a database of an ongoing advanced CAA cohort of patients admitted to the Massachusetts General Hospital since July 1994, as previously described [15]. We included participants admitted until 2019 whose MRI protocol contained T1, FLAIR, T2*-GRE and SWI sequences, all obtained in single sessions, excluding patients with incomplete imaging protocols or imaging artifacts from blood-sensitive MRIs, either SWI or T2*-GRE, that could significantly compromise analysis. This

Sample characteristics

Of 198 participants screened, 117 had incomplete MRI protocols, five were controls and 22 had blood-sensitive MRI with major imaging artifacts that compromised evaluation, and were excluded (Fig. 1). Our sample was thus composed of 54 patients admitted from 2007 until 2015; male gender predominated (n = 45, 83%) and mean age was 73.25 years (SD ± 8.33). There were 51 cases of probable CAA (94.4%), 12 of them with supporting pathology; and three cases (5.6%) of definite CAA (Table 1). Hypertension

Discussion

We compiled imaging data gathered prospectively from a single center cohort of patients with advanced CAA and compared cSS ratings between SWI and GRE-T2* made by differently experienced researchers. Some of the key findings are that: I) using two different blood-sensitive MRI sequences, the two raters detected cSS and computed the number of foci equivalently, with no reliability impairment; and II) both raters found more disseminated cSS on SWI studies, in agreement with the T2*-GRE

Conclusions

In our sample of advanced CAA patients, assessments made by raters using SWI were found to yield a higher percentage of disseminated cSS compared to GRE-T2* assessments. Our post hoc analysis also showed that GRE-T2* and SWI yielded different results when evaluating cSS multifocality, with higher scores seen with SWI. Interrater agreement was equivalent for the two sequences: good to very good for almost all parameters analyzed, including detection of cSS and foci count, though experience may

Funding

No funding.

Disclosure of interest

The authors declare that they have no competing interest.

Acknowledgements

The authors are foremost thankful to the Massachusetts’ General Hospital and the J. Philip Kistler Stroke Research Center colleagues and tutors.

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