JAMA Neurol:脑淀粉样血管病相关炎症的临床和影像学诊断标准

2016-01-21 phylis 译 MedSci原创

背景:在临床实践中,脑淀粉样血管病相关炎症(CAA-ri)是一种重要的诊断,因为很多患者会进行针对免疫抑制的治疗。CAA-ri可靠的无创性诊断标准使得一些患者避免脑活检。目标:测试CAA-ri的临床和神经影像学诊断标准的灵敏度和特异性。设计,设置和参与者:研究者修改了先前提出的临床影像学诊断标准,并且回顾性分析了CAA-ri和CAA非炎症患者的临床病历记录和磁共振成像液体衰减反转恢复梯度回波扫描。

背景:在临床实践中,脑淀粉样血管病相关炎症(CAA-ri)是一种重要的诊断,因为很多患者会进行针对免疫抑制的治疗。CAA-ri可靠的无创性诊断标准使得一些患者避免脑活检。

目标:测试CAA-ri的临床和神经影像学诊断标准的灵敏度和特异性。

设计,设置和参与者:研究者修改了先前提出的临床影像学诊断标准,并且回顾性分析了CAA-ri和CAA非炎症患者的临床病历记录和磁共振成像液体衰减反转恢复梯度回波扫描。在1995年10月1日和2013年5月31日,2009年1月1日和2011年12月31日间,共有病理诊断为CAA-ri的患者17例,对照组为病理诊断为非炎症CAA患者37人。对照组患者进一步分为,过去脑出血患者(ICH)(n=21)、脑微出血及无ICH史的患者(n = 16)。分析的日期为2012年9月1日到2015年8月31日。

主要成果和措施:诊断Probable CAA-ri(需要不对称的白质高信号延伸到皮质下白质)和Possible CAA-ri(要求白质高信号是对称的)预设标准的敏感性和特异性。

结果:CAA -ri组17例患者,平均(SD)年龄为68(8)岁,8例为(47%)女性。在CAA-ri组,14/17(82%)满足两种CAA-ri的标准。在ICH的非炎症CAA的对照组,1/21(5%)符合Possible CAA-ri的标准,没有患者达到Probable CAA-ri的标准。在没有ICH的非炎症性CAA的对照组,11/16(69%)符合Possible CAA-ri的标准,和1/16(6%)患者符合Probable CAA-ri 的诊断标准。这些研究结果显示:诊断为Probable CAA-ri的标准的敏感性和特异性分别为82%和97%,诊断为Possible CAA-ri的标准的敏感性和特异性分别为82%和68%。

结论与相关性:研究数据表明,CAA-ri的临床和影像学诊断标准敏感性和特异性均较好。

原文出处:

Auriel E, Charidimou A, et al. Validation of Clinicoradiological Criteria for the Diagnosis of Cerebral Amyloid Angiopathy-Related Inflammation. JAMA Neurol. 2015 Dec 28.

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    2016-05-17 yinhl1978
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    2016-01-27 李继凯

    好东西

    0

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