Main Article Content
Introduction: MRI biomarkers of small vessel damage in cerebral amyloidangiopathy (CAA) include small, and typically silent, strictly lobar cerebral microbleeds (CMBs) and cortical superﬁcial siderosis (cSS). To assess the association of cortical superﬁcial siderosis (cSS) presence and extent with future bleeding risk including in CAA, other general and oral procedures.
Material and Methods: This was a meta-analysis of clinical cohorts of symptomatic patients with CAA who had T2*- MRI at baseline and clinical follow-up for future intracerebral hemorrhage (ICH). We pooled data in a 2-stage meta-analysis using random eﬀects models. Covariate-adjusted hazard ratios (adjHR) from multivariable Cox proportional hazard models were used.
Results: We included data from 6 eligible studies (n = 1,239). cSS pooled prevalence was 34%. During a mean follow-up of 3.1 years, 162/ 1,239 patients experienced a symptomatic ICH-pooled incidence rate 6.9% per year. ICH incidence rates per year according to cSS status were 3.9% for patients without cSS, 11.1% for cSS presence, 9.1% for focal cSS, and 12.5% for disseminated cSS. In adjusted pooled analysis, any cSS presence was independently associated with increased future ICH risk. Focal cSS was linked with ICH risk, while disseminated cSS conferred the strongest bleeding risk.
Conclusion: In patients with CAA, cSS presence and extent are the most important MRI prognostic risk factors for future ICH, likely useful in treatment planning.