• Andreas Charidimou, Karim Farid, and Jean-Claude Baron.
• From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France. andreas.charidimou.09@ucl.ac.uk.
• Neurology. 2017 Oct 3; 89 (14): 1490-1498.

ObjectiveTo perform a meta-analysis synthesizing evidence of the value and accuracy of amyloid-PET in diagnosing patients with sporadic cerebral amyloid angiopathy (CAA).MethodsIn a PubMed systematic literature search, we identified all case-control studies with extractable data relevant for the sensitivity and specificity of amyloid-PET positivity in symptomatic patients with CAA (cases) vs healthy participants or patients with spontaneous deep intracerebral hemorrhage (ICH) (control groups). Using a hierarchical (multilevel) logistic regression model, we calculated pooled diagnostic test accuracy.ResultsSeven studies, including 106 patients with CAA (>90% with probable CAA) and 151 controls, were eligible and included in the meta-analysis. The studies were of moderate to high quality and varied in several methodological aspects, including definition of PET-positive and PET-negative cases and relevant cutoffs. The sensitivity of amyloid-PET for CAA diagnosis ranged from 60% to 91% and the specificity from 56% to 90%. The overall pooled sensitivity was 79% (95% confidence interval [CI] 62-89) and specificity was 78% (95% CI 67-86) for CAA diagnosis. A predefined subgroup analysis of studies restricted to symptomatic patients presenting with lobar ICH CAA (n = 58 vs 86 controls) resulted in 79% sensitivity (95% CI 61-90%) and 84% specificity (95% CI 65-93%). In prespecified bivariate diagnostic accuracy meta-analysis of 2 studies using 18F-florbetapir-PET, the sensitivity for CAA-ICH diagnosis was 90% (95% CI 76-100%) and specificity was 88% (95% CI 74-100%).ConclusionsAmyloid-PET appears to have moderate to good diagnostic accuracy in differentiating patients with probable CAA from cognitively normal healthy controls or patients with deep ICH. Given that amyloid-PET labels both cerebrovascular and parenchymal amyloid, a negative scan might be useful to rule out CAA in the appropriate clinical setting.© 2017 American Academy of Neurology.

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