Abstract Details

Title Predictive Value of Clinical, Cerebrospinal Fluid, & Vessel Wall MRI Variables in Diagnosing Primary Angiitis of the CNS

Topic Autoimmune Neurology

Presentation(s) P7 - Poster Session 7 (11:45 AM-12:45 PM)

Poster/Presentation
Number 14-006

Objective To assess if a combination of clinical, cerebrospinal fluid (CSF), and quantitative vessel-wall magnetic resonance imaging (VWMRI) markers can predict Primary Angiitis of the Central Nervous System (PACNS) with and without brain biopsy.

Background Without brain biopsy, there are limited diagnostic predictors to differentiate PACNS from non-inflammatory cerebral vasculopathy.

Design/Methods In this cross-sectional study, we reviewed electronic medical records to identify patients (≥18 years old) who presented to our medical center between 01/2015 and 12/2021 with ischemic stroke due to biopsy-proven PACNS and probable PACNS (not-biopsy proven). For the comparison group, we identified patients with non-inflammatory vasculopathy with intracranial atherosclerotic disease (ICAD). Patients with no CSF or VWMRI data were excluded. Using logistic regression models in primary and sensitivity analyses, we assessed the diagnostic value of clinical, CSF and quantitative VWMRI variables in predicting PACNS in patients with and without brain biopsy.

Results Twenty-seven (45.8%) PACNS patients and thirty-two (54.2%) ICAD patients (54?2%) met the study inclusion criteria. Twenty-four (75%) ICAD patients and 6 (22?2%) biopsy-proven PACNS patients showed large vessel involvement and were included in the primary analysis. Encephalopathy (odds ratio [OR], 7?60; 95% confidence interval [CI], 1?07-54?09) and seizure (OR 23?00; 95% CI, 1?77-298?45) were significantly associated with PACNS. All patients were included in the sensitivity analysis, in which headache significantly predicted PACNS (OR 7?60; 95% CI, 1?07-54?09). In the primary analysis, for every 1 WBC/uL increase in CSF, there was a 47% higher odds of PACNS (OR 1?47; 95% CI, 1?04-2?07). On VWMRI, a C/E ratio >1 (OR 115?00; 95% CI, 6?11-2165?95), percent concentricity ≥50% (OR 55?00; 95% CI, 4?13-732?71), and percent irregularity <50% (OR 55?00; 95% CI, 4?13-732?71) indicated a significantly higher odds of PACNS compared to ICAD.

Conclusions Quantitative VWMRI metrics, CSF pleocytosis, and clinical features of encephalopathy, seizure, and headache significantly predict a diagnosis of probable PACNS.

Authors/Disclosures
Aaron Shoskes, DO (University of Utah) PRESENTER	Dr. Shoskes has nothing to disclose.
Abbas Kharal, MD (Cleveland Clinic)	Dr. Kharal has nothing to disclose.
Sidonie E. Ibrikji, MD (Cleveland Clinic)	No disclosure on file
Youssef Farag (Bayer US LLC)	No disclosure on file
Matthew Kiczek	No disclosure on file
Richa Sheth (Northeast Ohio Medical University)	No disclosure on file
Muhammad S. Hussain, MD (Cleveland Clinic)	Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tiger Medical.

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