title: Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage.
abstract: BACKGROUND
  The Boston criteria are the basis for a noninvasive diagnosis of cerebral amyloid angiopathy (CAA) in the setting of lobar intracerebral hemorrhage (ICH). We assessed the accuracy of these criteria in individuals with lobar microbleeds (MBs) without ICH.
  
  
  METHODS
  We identified individuals aged >55 years having brain magnetic resonance imaging (MRI) and pathological assessment of CAA in a single academic hospital and a community-based population (Framingham Heart Study [FHS]). We determined the positive predictive value (PPV) of the Boston criteria for CAA in both cohorts, using lobar MBs as the only hemorrhagic lesion to fulfill the criteria.
  
  
  RESULTS
  We included 102 individuals: 55 from the hospital-based cohort and 47 from FHS (mean age at MRI 74.7 ± 8.5 and 83.4 ± 10.9 years; CAA prevalence 60% and 46.8%; cases with any lobar MB 49% and 21.3%; and cases with ≥2 strictly lobar MBs 29.1% and 8.5%, respectively). PPV of "probable CAA" (≥2 strictly lobar MBs) was 87.5% (95% confidence interval [CI], 60.4-97.8) and 25% (95% CI, 13.2-78) in hospital and general populations, respectively.
  
  
  CONCLUSIONS
  Strictly lobar MBs strongly predict CAA in non-ICH individuals when found in a hospital context. However, their diagnostic accuracy in the general population appears limited.
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA; Escola de Postgrau, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: srmartinez@mgh.harvard.edu.
authors.forename: Sergi
authors.initials: S
authors.lastname: Martinez-Ramirez
authors.affiliation: Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA.
authors.forename: Jose-Rafael
authors.initials: JR
authors.lastname: Romero
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Shoamanesh
authors.affiliation: Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA; Department of Pathology, School of Medicine, Boston University, Boston, MA, USA; United States Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA.
authors.forename: Ann C
authors.initials: AC
authors.lastname: McKee
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ellis
authors.initials: E
authors.lastname: Van Etten
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Octavio
authors.initials: O
authors.lastname: Pontes-Neto
authors.affiliation: Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Macklin
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Ayres
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Eitan
authors.initials: E
authors.lastname: Auriel
authors.affiliation: NHLBI's Framingham Heart Study, Framingham, MA, USA; Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA.
authors.forename: Jayandra J
authors.initials: JJ
authors.lastname: Himali
authors.affiliation: Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA; Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA.
authors.forename: Alexa S
authors.initials: AS
authors.lastname: Beiser
authors.affiliation: Department of Neurology, University of California-Davis, Sacramento, CA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.affiliation: Department of Pathology, School of Medicine, Boston University, Boston, MA, USA; United States Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA.
authors.forename: Thor D
authors.initials: TD
authors.lastname: Stein
authors.affiliation: Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; Center for the Study of Traumatic Encephalopathy, Boston University Alzheimer Disease Center, Boston, MA, USA.
authors.forename: Victor E
authors.initials: VE
authors.lastname: Alvarez
authors.affiliation: Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Charlestown, MA, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Frosch
authors.affiliation: Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: M Edip
authors.initials: ME
authors.lastname: Gurol
authors.affiliation: Department of Neurology, School of Medicine, Boston University, Boston, MA, USA; NHLBI's Framingham Heart Study, Framingham, MA, USA.
authors.forename: Sudha
authors.initials: S
authors.lastname: Seshadri
authors.affiliation: Neurology Department, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D016657:Cerebral Amyloid Angiopathy / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests
keywords: Boston criteria; Cerebral amyloid angiopathy; Intracerebral hemorrhage; Likelihood ratio; Microbleed; Predictive value; Sensitivity; Specificity