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Research ArticleAdult Brain
Open Access

Peak Width of Skeletonized Mean Diffusivity as Neuroimaging Biomarker in Cerebral Amyloid Angiopathy

N. Raposo, M.C. Zanon Zotin, D. Schoemaker, L. Xiong, P. Fotiadis, A. Charidimou, M. Pasi, G. Boulouis, K. Schwab, M.D. Schirmer, M.R. Etherton, M.E. Gurol, S.M. Greenberg, M. Duering and A. Viswanathan
American Journal of Neuroradiology May 2021, 42 (5) 875-881; DOI: https://doi.org/10.3174/ajnr.A7042
N. Raposo
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
bDepartment of Neurology (N.R.), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
cToulouse NeuroImaging Center (N.R.), Université de Toulouse, Institut National de la Santé et de la Recherche Médicale, Toulouse, UPS, France
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M.C. Zanon Zotin
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
dCenter for Imaging Sciences and Medical Physics (M.C.Z.Z.). Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil;, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
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D. Schoemaker
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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L. Xiong
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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P. Fotiadis
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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A. Charidimou
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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M. Pasi
eDepartment of Neurology (M.P.), Centre Hospitalier Universitaire de Lille, Lille, France
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G. Boulouis
fDepartment of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, Paris, France
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K. Schwab
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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M.D. Schirmer
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
gComputer Science and Artificial Intelligence Lab (M.D.S.), Massachusetts Institute of Technology, Boston, Massachusetts
hDepartment of Population Health Sciences (M.D.S.), German Center for Neurodegenerative Diseases, Bonn, Germany
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M.R. Etherton
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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M.E. Gurol
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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S.M. Greenberg
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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M. Duering
iMedical Image Analysis Center and Quantitative Biomedical Imaging Group (M.D.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
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A. Viswanathan
aFrom the Stroke Research Center (N.R., M.C.Z.Z., D.S., L.X., P.F., A.C., K.S., M.D.S., M.R.E., M.E.G., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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    FIG 1.

    FLAIR images from a subject with CAA-MCI (A) and one with a non-CAA-MCI (B), demonstrating different burdens of WMH. MD maps display the skeletonized WM tracts from the same subjects with CAA-MCI (C) and non-CAA-MCI (D). E, Histograms depict the MD values of the voxels contained in the WM tract skeleton from the same subjects with CAA-MCI (solid line) and non-CAA-MCI (dashed line). F, The boxplot represents group differences in PSMD between CAA-MCI and non-CAA-MCI. The dagger indicates the results derived from ANCOVA, adjusting for age at MRI (P < .001).

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    Table 1:

    Baseline characteristics of subjects with CAA-MCI and those with non-CAA-MCI

    CAA-MCI (n = 24)non-CAA-MCI (n = 62)P Value
    Demographics
        Age at NPT (mean) [SD] (yr)74.73 [5.99]73.25 [8.33].36
        Female (No.) (%)7 (29.2)26 (41.9).27
        Education (median) (IQR) (yr)16 (16, 18)16 (14, 18).04a
    Vascular risk factors
        Hypertension (No.) (%)13 (54.2)40 (64.5).38
        Diabetes (No.) (%)1 (4.2)10 (16.1).17
        Atrial fibrillation (No.) (%)4 (16.7)5 (8.1).26
        Dyslipidemia (No.) (%)13 (54.2)44 (71.0).14
    Neuropsychological performances
        MMSE (median) (IQR)25.5 (24–28)28 (26–29).006a
        MMSE (z score) (median) (IQR)–1.88 (–3.28, –0.16)0 (–1.48–1.11).003a
        Memory (z score) (median) (IQR)–1.91 (–2.38, –0.75)–0.47 (–1.60–0.56).005a
        Processing speed (z score) (median) (IQR)–0.24 (–0.62–0.15)–0.11 (–0.46–0.27).34
        Language (z score) (median) (IQR)–0.44 (–0.91–0.36)–0.36 (–1.17–0.19).95
        Executive function (z score) (median) (IQR)–0.59 (–1.89–0.22)–0.21 (–0.86–0.12).20
    Imaging
        PSMD (× 10–4 mm2/s) (median) (IQR)4.48 (3.81–5.09)3.63 (3.28–4.13)<.001a
        Lobar CMB count (median) (IQR)5.5 (3.0–24.50)0 (0–0)<.001a
        cSS (presence) (No.) (%)9 (37.5)0 (0.0)<.001a
        High CSO-PVS score (>2) (No.) (%)11 (45.8)3 (4.8)<.001a
        nWMHV (median) (IQR)0.42 (0.28–1.74)0.29 (0.14–0.75).02a
        nTBV (mean) [SD]0.61 [0.04]0.64 [0.05].004a
    • Note:—NPT indicates neuropsychological tests.

    • ↵a Significant.

    • View popup
    Table 2:

    Association between PSMD and MRI markers of small-vessel disease in subjects with CAA-MCI and non-CAA-MCIa

    Model 1bModel 2c
    Std. β95% CIPStd. β95% CIP
    CAA-MCI (n = 24)
        Lobar CMB count0.15–0.270.58.460.15–0.130.42.28
        cSS0.27–0.150.70.200.12–0.160.40.38
        CSO-PVS score0.31–0.090.71.130.20–0.100.49.18
        nWMHV0.750.491.02<.001d0.660.370.95<.001d
        nTBV–0.26–0.790.26.31–0.17–0.540.20.34
    Non-CAA-MCI (n = 62)
        CSO-PVS–0.02–0.240.21.870.10–0.070.27.25
        nWMHV0.690.500.89<.001d0.710.510.91<.001d
        nTBV–0.23–0.510.06.11–0.14–0.360.08.20
    • Note:—Std. β indicates standardized beta coefficient.

    • ↵a Linear regression models with PSMD (×10−4 mm2/s) as the dependent variable.

    • ↵b Simple Linear regression analyses adjusted for age.

    • ↵c Multiple regression models, including all neuroimaging markers and adjusted for age. In subjects with non-CAA-MCI, the presence of cSS and lobar CMB count was automatically excluded from the models due to the absence of variance within the group.

    • ↵d Significant.

    • View popup
    Table 3:

    Association between PSMD and cognitive performance in subjects with CAA-MCI and non-CAA-MCIa

    Adjusted Modelb
    Std. β95% CIP Value
    CAA-MCI (n = 24)
        Global cognitive status–0.40–1.210.41.31
        Memory–0.69–1.520.15.10
        Processing speed/attention–1.08–1.76–0.40.004c
        Language–0.47–1.160.21.16
        Executive function–0.64–1.370.10.09
    non-CAA-MCI (n = 62)
        Global cognitive status0.30–0.130.72.17
        Memory0.14–0.280.56.50
        Processing speed/attention0.16–0.270.59.46
        Language0.14–0.290.57.52
        Executive function0.11–0.300.53.58
    • ↵a Multiple regression models with cognitive performance as the dependent variable.

    • ↵b Models include PSMD, nWMHV, nTBV, CSO-PVS score, the presence of cSS and lobar CMB count; adjusting for the time delay between the neuropsychological evaluation and the MRI. In subjects with non-CAA-MCI, the presence of cSS and the lobar CMB count were automatically excluded from the models due to an absence of variance within the group.

    • ↵c Significant.

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N. Raposo, M.C. Zanon Zotin, D. Schoemaker, L. Xiong, P. Fotiadis, A. Charidimou, M. Pasi, G. Boulouis, K. Schwab, M.D. Schirmer, M.R. Etherton, M.E. Gurol, S.M. Greenberg, M. Duering, A. Viswanathan
Peak Width of Skeletonized Mean Diffusivity as Neuroimaging Biomarker in Cerebral Amyloid Angiopathy
American Journal of Neuroradiology May 2021, 42 (5) 875-881; DOI: 10.3174/ajnr.A7042

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Peak Width of Skeletonized Mean Diffusivity as Neuroimaging Biomarker in Cerebral Amyloid Angiopathy
N. Raposo, M.C. Zanon Zotin, D. Schoemaker, L. Xiong, P. Fotiadis, A. Charidimou, M. Pasi, G. Boulouis, K. Schwab, M.D. Schirmer, M.R. Etherton, M.E. Gurol, S.M. Greenberg, M. Duering, A. Viswanathan
American Journal of Neuroradiology May 2021, 42 (5) 875-881; DOI: 10.3174/ajnr.A7042
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