title: Clinical features of high-degree centrum semiovale-perivascular spaces in cerebral amyloid angiopathy.
abstract: BACKGROUND
  There is no doubt that cerebral amyloid angiopathy (CAA) is a key risk factor for recurrent lobar ICH, however, the exact mechanism and interaction with MRI markers of disease severity are less well known. Centrum semiovale-perivascular spaces (CSO-PVS) have been suggested as adjunctive diagnostic criteria in order to enhance diagnostic power. The purposes of this study were to investigate the prevalence of CSO-PVS and its association with other imaging signatures {lobar microbleeds (CMB), cortical superficial siderosis (CSS), white matter hyperintensity (WMH)} in lobar ICH patients as well as recurrent lobar ICH risk, especially in patients taking antithrombotic agents.
  
  
  METHODS
  This retrospective study included 85 patients who visited our institute between 2005 and 2013 with lobar ICH on magnetic resonance imaging(MRI). CSO-PVS were rated on axial T2-weighted sequences using a validated 2-point visual rating scale (high degree >20, low degree ≤20). The CSS, CMB and WMH were also evaluated. The relationship between CSO-PVS, CSS, CMB, antithrombotic usage and recurrent bleeding were explored.
  
  
  RESULTS
  A high degree of CSO-PVS was present in 71.8% of patients. The prevalence of CSS and CMB was higher in patients with a high degree of CSO-PVS (CSS, 49.2% vs. 16.7%, P=0.006; CMB count, 7.3% vs. 2.1%, P=0.002). A high degree of CSO-PVS and antithrombotic usage following lobar ICH was not associated with recurrent hemorrhage. In multivariate logistic regression analysis of predictors of recurrent lobar ICH in lobar ICH patients, post-ICH antithrombotics use and disseminated CSS are independently associated with increased risk of recurrent lobar ICH.
  
  
  CONCLUSIONS
  High-degree CSO-PVS is highly prevalent in probable cerebral amyloid angiopathy and is related to CSS and CMB. Disseminated CSS was associated with recurrent ICH in CAA. Our study might help physicians decide whether or not to use antithrombotic agents in hemorrhagic stroke patients with a high risk of ischemic stroke. A large prospective study is warranted to validate these findings.
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors.forename: Hae-Won
authors.initials: HW
authors.lastname: Koo
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurosurgery, Hana General Hospital, Cheongju, Korea.
authors.forename: Kyung-Il
authors.initials: KI
authors.lastname: Jo
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Je-Young
authors.initials: JY
authors.lastname: Yeon
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jong-Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: nsschong@skku.edu.
authors.forename: Seung-Chyul
authors.initials: SC
authors.lastname: Hong
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D016657:Cerebral Amyloid Angiopathy / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012806:Siderosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D066127:White Matter / Q000000981:diagnostic imaging / Q000187:drug effects
chemical_list: D005343:Fibrinolytic Agents
keywords: Centrum semiovale perivascular spaces; Cerebral amyloid angiopathy; Cerebral microbleed; Cortical superficial siderosis; Lobar intracerebral hemorrhage