Comparison of patients with biopsy positive and negative primary angiitis of the central nervous system
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissionsoup.com..
OBJECTIVE: There is limited evidence on when to obtain a central nervous system (CNS) biopsy in suspected primary angiitis of the central nervous system (PACNS). Our objective was to identify which clinical and radiological characteristics were associated with a positive biopsy in PACNS.
METHODS: From the multicenter retrospective Cohort of Patients with Primary Vasculitis of the CNS (COVAC), we included adults with PACNS based on a positive CNS biopsy or otherwise unexplained intracranial stenoses with additional findings supportive of vasculitis. Baseline findings were compared between patients with a positive and negative biopsy using logistic regression models.
RESULTS: 200 patients with PACNS were included, among which a biopsy was obtained in 100 (50%) and was positive in 61 (31%). Patients with a positive biopsy were more frequently female (OR 2.90, 95% CI 1.25-7.10, p = 0.01) and more often presented with seizures (OR 8.31, 95% CI 2.77-33.04, p < 0.001) or cognitive impairment (OR 2.58, 95% CI 1.11-6.10, p = 0.03). On imaging, biopsy positive patients more often had non-ischemic parenchymal or leptomeningeal gadolinium enhancement (OR 52.80, 95% CI 15.72-233.06, p < 0.001) or ≥ 1 cerebral microbleed (OR 8.08, 95% CI 3.03-25.13, p < 0.001), and less often had ≥ 1 acute brain infarct (OR 0.02, 95% CI 0.004-0.08, p < 0.001). In the multivariable model, non-ischemic parenchymal or leptomeningeal gadolinium enhancement (aOR 8.27, 95% CI 1.78-38.46), p < 0.01) and absence of ≥ 1 acute brain infarct (aOR 0.13, 95% CI 0.03-0.65, p = 0.01) were significantly associated with a positive biopsy.
CONCLUSIONS: Baseline clinical and radiological characteristics differed between biopsy positive and negative PACNS. These results may help physicians individualize the decision to obtain a CNS biopsy in suspected PACNS.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
Rheumatology (Oxford, England) - (2023) vom: 06. Okt. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nehme, Ahmad [VerfasserIn] |
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| Links: |
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| Themen: |
Biopsy |
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| Anmerkungen: |
Date Revised 06.10.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1093/rheumatology/kead542 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 100 | 1 | |a Nehme, Ahmad |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparison of patients with biopsy positive and negative primary angiitis of the central nervous system |
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| 500 | |a published: Print-Electronic | ||
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| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a OBJECTIVE: There is limited evidence on when to obtain a central nervous system (CNS) biopsy in suspected primary angiitis of the central nervous system (PACNS). Our objective was to identify which clinical and radiological characteristics were associated with a positive biopsy in PACNS | ||
| 520 | |a METHODS: From the multicenter retrospective Cohort of Patients with Primary Vasculitis of the CNS (COVAC), we included adults with PACNS based on a positive CNS biopsy or otherwise unexplained intracranial stenoses with additional findings supportive of vasculitis. Baseline findings were compared between patients with a positive and negative biopsy using logistic regression models | ||
| 520 | |a RESULTS: 200 patients with PACNS were included, among which a biopsy was obtained in 100 (50%) and was positive in 61 (31%). Patients with a positive biopsy were more frequently female (OR 2.90, 95% CI 1.25-7.10, p = 0.01) and more often presented with seizures (OR 8.31, 95% CI 2.77-33.04, p < 0.001) or cognitive impairment (OR 2.58, 95% CI 1.11-6.10, p = 0.03). On imaging, biopsy positive patients more often had non-ischemic parenchymal or leptomeningeal gadolinium enhancement (OR 52.80, 95% CI 15.72-233.06, p < 0.001) or ≥ 1 cerebral microbleed (OR 8.08, 95% CI 3.03-25.13, p < 0.001), and less often had ≥ 1 acute brain infarct (OR 0.02, 95% CI 0.004-0.08, p < 0.001). In the multivariable model, non-ischemic parenchymal or leptomeningeal gadolinium enhancement (aOR 8.27, 95% CI 1.78-38.46), p < 0.01) and absence of ≥ 1 acute brain infarct (aOR 0.13, 95% CI 0.03-0.65, p = 0.01) were significantly associated with a positive biopsy | ||
| 520 | |a CONCLUSIONS: Baseline clinical and radiological characteristics differed between biopsy positive and negative PACNS. These results may help physicians individualize the decision to obtain a CNS biopsy in suspected PACNS | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Primary angiitis of the central nervous system | |
| 650 | 4 | |a biopsy | |
| 650 | 4 | |a cerebral vasculitis | |
| 700 | 1 | |a Arquizan, Caroline |e verfasserin |4 aut | |
| 700 | 1 | |a Régent, Alexis |e verfasserin |4 aut | |
| 700 | 1 | |a Isabel, Clothilde |e verfasserin |4 aut | |
| 700 | 1 | |a Dequatre, Nelly |e verfasserin |4 aut | |
| 700 | 1 | |a Guillon, Benoit |e verfasserin |4 aut | |
| 700 | 1 | |a Capron, Jean |e verfasserin |4 aut | |
| 700 | 1 | |a Detante, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Lanthier, Sylvain |e verfasserin |4 aut | |
| 700 | 1 | |a Poppe, Alexandre Y |e verfasserin |4 aut | |
| 700 | 1 | |a Boulouis, Grégoire |e verfasserin |4 aut | |
| 700 | 1 | |a Godard, Sophie |e verfasserin |4 aut | |
| 700 | 1 | |a Terrier, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a Pagnoux, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Aouba, Achille |e verfasserin |4 aut | |
| 700 | 1 | |a Touzé, Emmanuel |e verfasserin |4 aut | |
| 700 | 1 | |a de Boysson, Hubert |e verfasserin |4 aut | |
| 700 | 0 | |a Cohort of Patients with PACNS study group |e verfasserin |4 aut | |
| 700 | 1 | |a Ayrignac, Xavier |e investigator |4 oth | |
| 700 | 1 | |a Zéphir, Hélène |e investigator |4 oth | |
| 700 | 1 | |a Néel, Antoine |e investigator |4 oth | |
| 700 | 1 | |a Mekinian, Arsène |e investigator |4 oth | |
| 700 | 1 | |a Létourneau-Guillon, Laurent |e investigator |4 oth | |
| 700 | 1 | |a Derex, Laurent |e investigator |4 oth | |
| 700 | 1 | |a Gerfaud-Valentin, Mathieu |e investigator |4 oth | |
| 700 | 1 | |a Quénardelle, Véronique |e investigator |4 oth | |
| 700 | 1 | |a Kremer, Laurent Daniel |e investigator |4 oth | |
| 700 | 1 | |a Gollion, Cédric |e investigator |4 oth | |
| 700 | 1 | |a Weisenburger, David |e investigator |4 oth | |
| 700 | 1 | |a Vautier, Matthieu |e investigator |4 oth | |
| 700 | 1 | |a Machado, Stéphanie |e investigator |4 oth | |
| 700 | 1 | |a Maarouf, Adil |e investigator |4 oth | |
| 700 | 1 | |a Humbertjean, Lisa |e investigator |4 oth | |
| 700 | 1 | |a Vannier, Stéphane |e investigator |4 oth | |
| 700 | 1 | |a Denier, Christian |e investigator |4 oth | |
| 700 | 1 | |a Casolla, Barbara |e investigator |4 oth | |
| 700 | 1 | |a Bresch, Saskia |e investigator |4 oth | |
| 700 | 1 | |a Levraut, Michael |e investigator |4 oth | |
| 700 | 1 | |a Hosseini, Hassan |e investigator |4 oth | |
| 700 | 1 | |a Lambert, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Subreville, Marie |e investigator |4 oth | |
| 700 | 1 | |a Papo, Thomas |e investigator |4 oth | |
| 700 | 1 | |a Sibon, Igor |e investigator |4 oth | |
| 700 | 1 | |a Comarmond-Ortoli, Chloé |e investigator |4 oth | |
| 700 | 1 | |a Mazighi, Mikael |e investigator |4 oth | |
| 700 | 1 | |a Kerschen, Philippe |e investigator |4 oth | |
| 700 | 1 | |a Sablot, Denis |e investigator |4 oth | |
| 700 | 1 | |a Gaudron, Marie |e investigator |4 oth | |
| 700 | 1 | |a Audemard-Verger, Alexandra |e investigator |4 oth | |
| 700 | 1 | |a Closs-Prophette, Fabienne |e investigator |4 oth | |
| 700 | 1 | |a Papassin, Jérémie |e investigator |4 oth | |
| 700 | 1 | |a Daelman, Laure |e investigator |4 oth | |
| 700 | 1 | |a Zuber, Mathieu |e investigator |4 oth | |
| 700 | 1 | |a Obadia, Michael |e investigator |4 oth | |
| 700 | 1 | |a Pico, Fernando |e investigator |4 oth | |
| 700 | 1 | |a Cantagrel, Paul |e investigator |4 oth | |
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| 700 | 1 | |a Poncet-Megemont, Louis |e investigator |4 oth | |
| 700 | 1 | |a Ancel, Thomas |e investigator |4 oth | |
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