22. European Stroke Conference 16 Brain imaging B 17:30 - 17:40 Amyloid imaging in cerebral amyloid angiopathy-related intracerebral hemorrhage (CAA-ICH): comparison to healthy age-matched controls J.C. Baron1, E. Dolan2, E. O’Brien3, F.I. Aigbirhio4, T.D. Fryer5, D.K. Menon6, E.A. Warbur-ton7, Y.T. Hong8 INSERM, Paris, FRANCE1,University of cambridge, cambridge, UNITED KINGDOM2, Addenbrooke’s Hospital, Cambridge, UNITED KINGDOM3, University of cambridge, Cam-bridge, UNITED KINGDOM4, University of cambridge, cambridge, UNITED KINGDOM5, University of cambridge, Cambridge, UNITED KINGDOM6, University of cambridge, Cam-bridge, UNITED KINGDOM7, University of cambridge, Cambridge, UNITED KINGDOM8 Background: By detecting Aβ40 in the wall of cortical arterioles, amyloid PET imaging might help in the diagnosis of CAA in first lobar ICHs not fulfilling the Boston criteria. In the only paper on CCA-ICH so far (Ly, Neurology, 2010), whole-brain 11C-PiB binding was signifi-cantly increased relative to age-matched healthy controls (HC). However, the regional distri-bution was assessed against Alzheimer’s disease (AD), not against HC, which is of limited usefulness for diagnostic applications. To address this issue, we directly compared CAA-ICH to HC. Methods: 11C-PiB PET and MRI including T2* were obtained in 11 non-demented pa-tients (70±7 yrs, MMSE 26.7±1.8) with lobar ICH from probable CAA Boston criteria) and 10 age-matched HC. Following post hoc exclusion of 1 HC due to presence of lobar microbleeds, the HC group comprised 9 subjects (65±5yrs, NS; MMSE range 29-30, p<0.001). Following spatial normalization, PiB binding potential (BPND) corrected for brain atrophy (CSF fraction) was quantified in anatomical ROIs (AAL template) using the reference tissue input Logan plot, for i) whole cerebral cortex (wcBPND) and ii) ROIs (calcarine, ant. and post. cingulum, occip-ital, prefrontal, lateral temporal, inf. and sup. parietal, and hippocampus). The 95% upper limit for wcBPND determined from 10 HC 24-55yrs was 1.22. Results: The wcBPND exceeded the 95%UL in all CAA pts vs 5/9 HC (p=0.025, Fisher), but was not significantly different between the 2 groups (1.34±.11 vs 1.38±.31, p=.68), neither were the ROI values. Both inf. and sup. pa-rietal ROI/wcBPND ratios were significantly different, but were lower in CAA than HC. ROI/ prefrontal ratios were not different for any region. Conclusion: 11C-PiB PET may not be of substantial diagnostic use for CAA-related ICH if normal subjects are used as reference, prob-ably due to the well-known frequent occurrence of high 11C-PiB in the asymptomatic healthy elderly reflecting incipient AD, which might also be present in suspected CAA. 15 Brain imaging B 17:20 - 17:30 Diffusion tensor imaging to identify structural change following lacunar stroke G.W.J. Harston1, T. Okell2, N. Blockley3, M. Chappell4, J. Levman5, Y.K. Tee6, F. Sheerin7, M. Cellerini8, N. Rane9, I. Reckless10, G. Pope11, P. Jezzard12, S. Payne13, J. Kennedy14 University of Oxford, Oxford, UNITED KINGDOM1,University of Oxford, Oxford, UNIT-ED KINGDOM2, University of Oxford, Oxford, UNITED KINGDOM3, University of Oxford, Oxford, UNITED KINGDOM4, University of Oxford, Oxford, UNITED KINGDOM5, Univer-sity of Oxford, Oxford, UNITED KINGDOM6, Oxford University Hospitals NHS Trust, Ox-ford, UNITED KINGDOM7, Oxford University Hospitals NHS Trust, Oxford, UNITED KING-DOM8, Oxford University Hospitals NHS Trust, Oxford, UNITED KINGDOM9, Oxford University Hospitals NHS Trust, Oxford, UNITED KINGDOM10, Oxford University Hospitals NHS Trust, Oxford, UNITED KINGDOM11, University of Oxford, Oxford, UNITED KINGDOM12, University of Oxford, Oxford, UNITED KINGDOM13, University of Oxford, Oxford, UNITED KINGDOM14 Introduction The pathophysiology of lacunar infarction is poorly understood, thus hindering specific acute treatment approaches. Diffusion tensor imaging (DTI), allows serial investigation of neuronal integrity within the ischaemic lesion. Data from patients with acute lacunar infarction are pre-sented here. Methods Patients with ischaemic stroke are recruited within 6hrs of symptom onset and undergo serial MRI: on presentation, at 1 day, 1 week and 1 month. MRI protocols include standard 3-di-rection DWI, fluid attenuated inversion recovery (FLAIR), quantitative arterial spin labeling (ASL) and 12-direction DTI. Regions of interest (ROI) were defined using DWI on presentation and co-registered FLAIR at 1 month. Core infarct was defined as DWI positive, FLAIR posi-tive (DWI+FLAIR+) and the mismatch between core and final infarct as DWI negative, FLAIR positive (DWI-FLAIR+). Mean diffusivity (MD), fractional anisotropy (FA) and perfusion were calculated in each ROI. Results MD increased over 1 month in all patients, having been reduced initially in the majority. How-ever, within the core infarct, the final MD was between 5 and 50% higher than the contralateral side. This was not seen within the surrounding DWI-FLAIR+ tissue. This is likely to represent liquefaction of the core tissue. Consistent with this observation is the decline in FA over time, most marked in the core infarct, with relative sparing of the surrounding DWI-FLAIR+ tissue. This is suggests tissue integrity is preserved in the surrounding area, despite infarction observed at 1 month. Conclusions DTI provides insight into the pathophysiology of lacunar infarction. These data suggest that DTI may be useful in distinguishing different pathophysiological processes within individual patients. Such an approach could allow targeting of specific treatments for patients who stand to benefit the most. DTI may also be useful as an imaging surrogate in phase 2 studies. 70 © 2013 S. Karger AG, Basel Scientific Programme
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