The Evaluation of Quantitative MRA for Cerebral Amyloid Angiopathy with Vascular Risk Factors

Cerebral amyloid angiopathy (CAA) is a leading cause of intracranial hemorrhage and cognitive decline in the elderly. This study seeks to investigate the quantitative MRA features as new markers of CAA. In this cross-sectional study, consecutive patients with CAA, along with controls, who underwent 3DTime-of-flight-MRA were included. Demographic and clinical data, including sex, age, diabetes, smoking, hypertension, and atrial fibrillation, were collected. Radiologic features, including the microhemorrhage classification, siderosis, and Fazekas scale, were also collected. Using in-house developed semi-automated software (VesselVoyager), quantitative MRA features, including total arterial length, number of branches, and tortuosity, were extracted. Univariable and multivariable logistic regression analyses were then performed to compare the CAA and non-CAA cohorts. Seventy-four patients were included: 43 with CAA and 31 controls. Quantitative MRA analysis showed that patients with CAA had significantly reduced total arterial length (1900±1240 mm vs. 2880±1540 mm, p=0.006). Univariable logistic regression identified total arterial length (p=0.009), age (p=0.012), and total branch number (p=0.107) as relevant predictors of CAA. In multivariable analysis, total arterial length (OR = 0.95; 95% CI: 0.92-0.99; p=0.014) and age (1.06; 1.01-1.12; p=0.023) remained independently associated with CAA diagnosis. Quantitative MRA total arterial length is inversely independently and significantly associated with CAA diagnosis. This could potentially serve as an imaging marker of CAA diagnosis and potentially further elucidate vascular segment involvement in CAA patients. CAA = Cerebral amyloid angiopathy; TOF-MRA = Time-of-flight MRA; LDL = Low-density lipoprotein; BMI = Body mass index.