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. 2025 Jun 24:23969873251349657.
doi: 10.1177/23969873251349657. Online ahead of print.

Cerebral amyloid angiopathy and amyloid load distribution detected on amyloid-positron emission tomography: A systematic review and meta-analysis

Aikaterini Theodorou  1 , Konstantinos Melanis  1 , Athanasia Athanasaki  1 , Lina Palaiodimou  1 , Maria-Ioanna Stefanou  1   2   3 , Panagiota-Eleni Tsalouchidou  1 , Efthimios Vassilopoulos  4 , Anastasios Kouzoupis  4 , Marios Themistocleous  5 , Georgios P Paraskevas  1 , Georgios Tsivgoulis  1 , Elias Tzavellas  4
Affiliations

Cerebral amyloid angiopathy and amyloid load distribution detected on amyloid-positron emission tomography: A systematic review and meta-analysis

Aikaterini Theodorou et al. Eur Stroke J. .

Abstract

Introduction: There are limited data regarding the amyloid positron emission tomography (PET) imaging among patients with Cerebral Amyloid Angiopathy (CAA). We sought to assess the amyloid load distribution detected on amyloid-PET among CAA patients compared to patients with Alzheimer's Disease (AD), patients with hypertension (HTN) related hemorrhage (ICH) and healthy controls (HC).

Patients and methods: A systematic review and meta-analysis of published studies with available data on global and regional amyloid-PET uptake was conducted. Comparisons with respect to amyloid load distribution were investigated using random-effects models based on the ratio of mean (RoM) amyloid-PET uptake. RoM < 1 and RoM > 1 indicate lower and higher global or regional amyloid-PET uptake in CAA compared to another population, respectively.

Results: We identified 16 cohorts, comprising 271 CAA patients (mean age: 72 years; women: 46%) versus 130 AD patients (mean age: 73 years; women: 44%), 180 patients with HTN-related ICH (mean age: 66 years; women: 36%) and 61 HC (mean age: 71 years; women: 46%) with available data on amyloid-PET. Global amyloid PET ratio differentiated CAA from AD [RoM: 0.93; 95% CI: 0.90-0.96; p < 0.0001], HTN-related ICH [RoM: 1.25; 95% CI: 1.20-1.31; p < 0.0001], and HC [RoM: 1.26; 95% CI: 1.23-1.29; p < 0.0001]. Occipital amyloid-PET uptake [RoM: 1.20; 95% CI: 1.15-1.26; p < 0.0001] was higher in CAA compared to HTN-related ICH, and Occipital-to-global [RoM: 1.05; 95% CI: 1.03-1.07; p < 0.0001] ratio of amyloid-PET uptake differentiated also CAA from AD.

Conclusions: CAA is characterized by a distinct amyloid-PET burden and distribution compared to AD patients, patients with HTN-related ICH and HC. These findings may contribute to the design and conduct of future randomized controlled clinical trials, aiming to treat CAA at preclinical stages.

Keywords: Alzheimer’s disease; Cerebral amyloid angiopathy; amyloid load; hypertension; intracerebral hemorrhage; positron emission tomography.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Ratios for mean global amyloid PET distribution among patients with CAA and AD (Panel a), among patients with CAA and patients with HTN-related ICH (Panel b) and among patients with CAA and HC (Panel c).
Figure 2.
Figure 2.
Ratios for occipital-to-global amyloid PET distribution among patients with CAA and AD (Panel a), and among patients with CAA and HC (Panel b).
Figure 3.
Figure 3.
Ratio for occipital amyloid PET distribution among patients with CAA and HTN-related ICH.
See this image and copyright information in PMC

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References

    1. Charidimou A, Boulouis G, Gurol ME, et al. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain 2017; 140: 1829–1850. - PMC - PubMed
    1. Linn J, Halpin A, Demaerel P, et al. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Neurol 2010; 74: 1346–1350. - PMC - PubMed
    1. Charidimou A, Boulouis G, Frosch MP, et al. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol 2022; 21: 714–725. - PMC - PubMed
    1. Koemans EA, Chhatwal JP, van Veluw SJ, et al. Progression of cerebral amyloid angiopathy: a pathophysiological framework. Lancet Neurol 2023; 22: 632–642. - PubMed
    1. Greenberg SM, Bacskai BJ, Hernandez-Guillamon M, et al. Cerebral amyloid angiopathy and Alzheimer disease - one peptide, two pathways. Nat Rev Neurol 2020; 16: 30–42. - PMC - PubMed

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