Abstract Details

Title Diagnostic Value of the Boston criteria v2.0 for Cerebral Amyloid Angiopathy in Individuals Without Hemorrhage: An MRI-neuropathological Validation Study

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) S15 - Innovative Diagnostics in Dementia (2:36 PM-2:48 PM)

Poster/Presentation
Number 009

Background The Boston criteria were recently updated to incorporate non-hemorrhagic MRI biomarkers of CAA and small vessel disease. The updated criteria (v2.0) demonstrated improved diagnostic yield when compared to prior versions of the criteria (v1.5) among patients presenting with symptomatic CAA-related syndromes. However, these criteria have not been validated in any cohorts without symptomatic CAA.

Objective To assess the diagnostic performance of the Boston criteria version 2.0 for cerebral amyloid angiopathy (CAA) diagnosis in a cohort of individuals without symptomatic intracerebral hemorrhage or CAA-related transient focal neurological episodes (TFNE) and who had pathological assessment for CAA.

Design/Methods Fifty-four participants with a median age of 75, followed in large population-based or observational studies, were included if they had an antemortem MRI with gradient-recall echo sequences and a subsequent brain autopsy with CAA evaluation. Performance of the Boston criteria v2.0 was compared to v1.5 using pathologically verified CAA as the reference standard. Performance measures were calculated using a logistic regression. Paired AUC were compared using the pROC package in R.

Results

Overall, 28/54 participants had pathologically confirmed CAA (i.e. moderate-to-severe CAA in at least 1 cortical region). The sensitivity and specificity of the Boston criteria v2.0 were 78.6% (59.1-91.7) and 34.6% (17.2-55.7) for any CAA diagnosis (possible + probable; AUC: 0.57) and 28.6% (13.2-48.7) and 69.2% (48.2-85.7) for probable CAA diagnosis (AUC 0.49), respectively. The v2.0 Boston criteria had superior accuracy to the prior v1.5 criteria for any CAA diagnosis (AUC 0.57 [0.45-0.69] vs. AUC 0.43 [0.30-0.56], Z= 2.10, p= 0.03).

Conclusions The Boston criteria v2.0 have limited accuracy for CAA diagnosis in an asymptomatic population. Additional biomarkers may need to be explored in this setting to optimize CAA diagnostic performance.

Authors/Disclosures
Aaron R. Switzer, MD PRESENTER	Dr. Switzer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai Company Limited.
Antreas Charidimou, MD, PhD MSc	Dr. Charidimou has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care. Dr. Charidimou has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier, Journal of Neurological Sciences.
Stuart McCarter, MD (Mayo Clinic)	Dr. McCarter has received research support from NIH.
Scott Przybelski	Scott Przybelski has nothing to disclose.
Timothy Lesnick	No disclosure on file
Prashanthi Vemuri, PhD (Mayo Clinic)	The institution of Dr. Vemuri has received research support from NIH.
Ross Reichard	Ross Reichard has nothing to disclose.
Alejandro A. Rabinstein, MD, FAAN (Mayo Clinic)	Dr. Rabinstein has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shionogi . Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceribell. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical care/NCS-Springer. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters/UptoDate. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO/DynaMed. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care.
David S. Knopman, MD, FAAN (Mayo Clinic)	Dr. Knopman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for DIAN TU study. The institution of Dr. Knopman has received research support from NIH.
Ronald C. Petersen, MD, PhD, FAAN (Mayo Clinic)	Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly and Co.. Dr. Petersen has received personal compensation in the range of $0-$499 for serving as a Consultant for Eisai, Inc.. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novo Nordisk. Dr. Petersen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has received publishing royalties from a publication relating to health care. Dr. Petersen has a non-compensated relationship as a Board of Directors with American Brain Foundation that is relevant to AAN interests or activities.
Jonathan Graff-Radford, MD, FAAN	Dr. Graff-Radford has received personal compensation for serving as an employee of Mayo Clinic. Dr. Graff-Radford has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NINDS/NIH. The institution of Dr. Graff-Radford has received research support from NIH. The institution of Dr. Graff-Radford has received research support from Eisai. The institution of Dr. Graff-Radford has received research support from Cognition therapeutics.

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