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© 2010 American Academy of Neurology 11C-PIB binding is increased in patients with cerebral amyloid angiopathy–related hemorrhageFrom the National Stroke Research Institute (J.V.L., G.A.D., J.A.Z., H.M., R.M.G., L.C.), University of Melbourne, Austin Health, Heidelberg Heights; Department of Nuclear Medicine (V.L.V., G.O., S.J.G., T.S., U.A., H.T.-D., C.C.R.), Centre for PET, Austin Health, Heidelberg; and Department of Neurosciences (T.G.P.), Monash Medical Centre, Clayton, Victoria, Australia. Address correspondence and reprint requests to Prof. Geoff A. Donnan, National Stroke Research Institute, Level 1, Neurosciences Building, Austin Health, University of Melbourne, 300 Waterdale Rd., Heidelberg Heights, Victoria 3081, Australia gdonnan{at}unimelb.edu.au Background: The in vivo diagnosis of cerebral amyloid angiopathy (CAA) is inferred from clinical and structural imaging features. 11C-Pittsburgh compound B (PIB) is a PET ligand that binds to β-amyloid in extracellular plaques and vessel walls. We hypothesized that patients with a clinical diagnosis of CAA-related hemorrhage (CAAH) have increased 11C-PIB uptake and that the pattern differs from Alzheimer disease (AD). Methodology: Patients with CAAH based on established clinical criteria were studied using 11C-PIB PET and were compared with age-matched controls and patients with AD. Distribution volume ratio (DVR) parametric maps were created using the cerebellar cortex as a reference region. Results: Twelve patients with CAAH of mean age 73.9 (range 58-93) years were compared with 22 normal controls and 13 patients with AD of mean age 71.8 (59-83) and 73.8 (56-90) years, respectively. CAAH PIB median DVR binding was higher in cortical regions (1.69, interquartile range 1.44-1.97) compared with controls (1.32, 1.21-1.44, p = 0.002) but lower than AD (2.04, 1.93-2.26, p = 0.004). The occipital-global uptake ratio was lower among patients with AD than among patients with CAAH (p = 0.008), and the frontal-global uptake ratio was higher (p = 0.012). Conclusion: 11C-Pittsburgh compound B (PIB) binding is moderately increased in most patients with probable cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage. The distribution may differ from that seen in Alzheimer disease. 11C-PIB PET may assist in the in vivo diagnosis of CAA and serve as a surrogate marker for future therapeutic studies.
Abbreviations: AD = Alzheimer disease; Aβ = β-amyloid; CAA = cerebral amyloid angiopathy; CAAH = cerebral amyloid angiopathy-related hemorrhage; CDR = Clinical Dementia Rating; DVR = distribution volume ratio; GRE = gradient echo; ICH = intracerebral hemorrhage; IQCODE = Informant Questionnaire on Cognitive Decline in the Elderly; IQR = interquartile range; MMSE = Mini-Mental State Examination; PIB = Pittsburgh compound B; RAMLA = row-action maximum likelihood algorithm; TAC = time activity curve.
Supplemental data at www.neurology.org Study funding: Supported by a Pfizer Cardio Vascular Lipid (CVL) research grant and the National Health and Medical Research Council. The sponsor had no part in the design of the study, data collection, analysis, interpretation of data, writing of this report or the decision to submit the paper for publication. Disclosure: Author disclosures are provided at the end of the article. Received July 2, 2009. Accepted in final form November 9, 2009. This article has been cited by other articles:
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