Posterior-to-anterior periventricular white matter hyperintensity area ratio: a supportive MRI feature for differentiating cerebral amyloid angiopathy in lobar intracerebral hemorrhage

作者：Y J Zhang, Sihui Wang, Xinrong Wu, Yao Zhong, Shengjun Sun, Yi Ju · 发表于：BMC Neurology · 年份：2026 · DOI：10.1186/s12883-026-04992-5 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Dementia and Cognitive Impairment Research、Acute Ischemic Stroke Management

BACKGROUND: Diagnosing cerebral amyloid angiopathy (CAA) in primary lobar intracerebral hemorrhage (ICH) remains challenging using routine MRI markers. We investigated a quantitative posterior-dominant pattern of periventricular white matter hyperintensity (PWMH) as a potential supportive imaging feature for CAA within the Boston v2.0 framework. METHODS: We retrospectively analyzed 229 patients aged ≥ 50 years with primary lobar ICH, classified as CAA (n = 123) or CAA-negative (n = 106) according to the Boston criteria v2.0. On FLAIR, the largest anterior and posterior periventricular WMH areas were measured bilaterally, and the posterior-to-anterior PWMH area ratio (PA-AR) was derived. Multivariable logistic regression models were developed, and diagnostic performance was evaluated using ROC analysis. RESULTS: Patients with CAA showed a greater posterior PWMH burden and higher PA-AR than CAA-negative controls (median 1.69 vs. 0.79; p < 0.001). Adding PA-AR to the covariate-adjusted model improved discrimination for CAA (AUC 0.804; bootstrap mean AUC 0.813, 95% CI 0.759-0.867). In the predefined diagnostic "gray zone" subgroup, PA-AR remained informative. The AUC was 0.887 in univariable analysis and 0.888 after age adjustment. PA-AR was also higher in patients with posterior lobar CMBs than in those with no CMBs or mixed-location hemorrhage. CONCLUSIONS: A posterior-dominant periventricular WMH pattern, quantified by PA-AR, is associated with CAA in lobar ICH. This pattern i...