{"id":76901,"date":"2025-03-14T08:49:44","date_gmt":"2025-03-14T07:49:44","guid":{"rendered":"http:\/\/andreaforneris.com\/web\/?p=76901"},"modified":"2025-05-14T09:15:24","modified_gmt":"2025-05-14T07:15:24","slug":"i-criteri-di-boston-utilizzati-per-la-diagnosi-della-angiopatia-amiloide-cerebrale-caa-in-rm","status":"publish","type":"post","link":"http:\/\/andreaforneris.com\/web\/i-criteri-di-boston-utilizzati-per-la-diagnosi-della-angiopatia-amiloide-cerebrale-caa-in-rm\/","title":{"rendered":"I Criteri di Boston utilizzati per la diagnosi della angiopatia amiloide cerebrale (CAA) in RM"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text css=””]I Criteri di Boston (Boston Criteria) sono utilizzati per la diagnosi della angiopatia amiloide cerebrale (CAA), in particolare la forma sporadica che colpisce gli anziani, ed \u00e8 associata a emorragie cerebrali lobari. Nel contesto della risonanza magnetica (RM), i criteri sono fondamentali per definire stadi probabilistici (possibile, probabile) di CAA in assenza di biopsia o autopsia cerebrale. I <\/span>criteri <\/span>originali (<\/span>2002) <\/span>sono <\/span>stati <\/span>aggiornati <\/span>nel <\/span>2022<\/span><\/strong> con <\/span>i <\/span>cosiddetti <\/span>Modified <\/span>Boston <\/span>Criteria <\/span>v2.0<\/span><\/strong>, <\/span>che <\/span>migliorano <\/span>la <\/span>sensibilit\u00e0 <\/span>diagnostica <\/span>con <\/span>l\u2019inclusione <\/span>di <\/span>nuove <\/span>evidenze <\/span>da <\/span>RM.<\/span>[\/vc_column_text][vc_column_text css=””]<\/p>\n

Diagnosi: CAA certa<\/i><\/span><\/h3>\n

La diagnosi \u00e9 su base di analisi istologiche post mortem, quindi non possibile con RM<\/p>\n

[\/vc_column_text][vc_column_text css=””]<\/p>\n

Diagnosi: CAA probabile supportata da istologici<\/i><\/span><\/h3>\n

Viene definita sulla base di una Biopsia <\/span>locale <\/span>positiva <\/span>per <\/span>amiloide <\/span>vascolare<\/span> +<\/span> quadro <\/span>clinico <\/span>compatibile, e tiene anche conto di eventuali informazioni ricavabili dall’imaging RM come un Emorragia lobare spontanea o o Microemorragie lobari\u00a0<\/span><\/p>\n

[\/vc_column_text][vc_column_text css=””]<\/p>\n

Diagnosi: <\/span>Probabile <\/span>CAA <\/span>senza <\/span>conferma <\/span>patologica<\/span><\/em><\/h3>\n

Richiede <\/span>TUTTI<\/span> i <\/span>seguenti <\/span>criteri:<\/span><\/p>\n

    \n
  1. \n

    Et\u00e0 \u2265 <\/span>55 <\/span>anni<\/span><\/p>\n<\/li>\n

  2. \n

    Nessun’altra <\/span>causa <\/span>identificabile<\/span> per <\/span>le <\/span>anomalie <\/span>emorragiche.<\/span><\/p>\n<\/li>\n

  3. \n

    Presenza <\/span>di <\/span>almeno <\/span>uno <\/span>dei <\/span>seguenti <\/span>segni <\/span>di <\/span>emorragia <\/span>non <\/span>traumatica:<\/span><\/p>\n

      \n
    • \n

      Due <\/span>o <\/span>pi\u00f9<\/span> emorragie <\/span>intracerebrali <\/span>lobari, <\/span>cortico-<\/span>sottocorticali, <\/span>distribuite <\/span>in <\/span>pi\u00f9 <\/span>lobi <\/span>cerebrali, <\/span>oppure:<\/span><\/p>\n<\/li>\n

    • \n

      Una <\/span>sola<\/span> emorragia <\/span>lobare <\/span>associata <\/span>a:<\/span><\/p>\n

        \n
      • \n

        Microemorragie <\/span>lobari <\/span>multiple (\u2265<\/span>2)<\/span>, <\/span>oppure<\/span><\/p>\n<\/li>\n

      • \n

        Segni <\/span>di <\/span>siderosi <\/span>superficiale <\/span>corticale (<\/span>cSS)<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n

      • \n

        Distribuzione <\/span>tipica <\/span>delle <\/span>lesioni<\/span>:<\/span><\/p>\n

          \n
        • \n

          Emorragie <\/span>localizzate <\/span>solo<\/span> in <\/span>regioni <\/span>lobari, <\/span>corticali <\/span>o <\/span>sottocorticali<\/span> (<\/span>no <\/span>gangli <\/span>della <\/span>base, <\/span>talamo, <\/span>tronco, <\/span>cervelletto <\/span>in <\/span>modo <\/span>predominante).<\/span><\/p>\n<\/li>\n

        • \n

          Assenza <\/span>di <\/span>cause <\/span>alternative<\/span> (<\/span>ad <\/span>es. <\/span>trauma, <\/span>tumore, <\/span>malformazioni, <\/span>coagulopatie).<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n

          [\/vc_column_text][vc_separator][vc_column_text css=””]<\/p>\n

          Segni tipici <\/span>RM che vengono <\/span>considerati <\/span>nei <\/span>criteri<\/span><\/h2>\n
            \n
          1. \n

            Emorragie <\/span>intracerebrali <\/span>lobari<\/span><\/strong><\/h3>\n
              \n
            • \n

              Iperintense <\/span>in <\/span>T1\/<\/span>T2 <\/span>e <\/span>ipointense <\/span>in <\/span>T2*-<\/span>GRE <\/span>o <\/span>SWI.<\/span><\/p>\n<\/li>\n

            • \n

              Localizzate <\/span>nei <\/span>lobi <\/span>cerebrali, <\/span>solitamente <\/span>parietale\/<\/span>occipitale.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n

            • \n

              Microemorragie <\/span>cerebrali\u00a0<\/span><\/strong><\/h3>\n
                \n
              • \n

                Piccole <\/span>aree <\/span>ipointense (<<\/span>10 <\/span>mm) <\/span>visibili <\/span>su <\/span>T2*-<\/span>GRE <\/span>o <\/span>SWI.<\/span><\/p>\n<\/li>\n

              • \n

                Devono <\/span>essere <\/span>lobari<\/span><\/strong> per <\/span>essere <\/span>compatibili <\/span>con <\/span>CAA.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n

              • \n

                Siderosi <\/span>superficiale <\/span>corticale (<\/span>cSS)<\/span><\/strong><\/h3>\n
                  \n
                • \n

                  Depositi <\/span>lineari <\/span>di <\/span>emosiderina <\/span>sulla <\/span>superficie <\/span>corticale (<\/span>es. <\/span>solchi), <\/span>visibili <\/span>su <\/span>SWI <\/span>o <\/span>T2*-<\/span>GRE.<\/span><\/p>\n<\/li>\n

                • \n

                  Segno <\/span>molto <\/span>specifico <\/span>per <\/span>CAA.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n

                • \n

                  Lacune <\/span>ischemiche<\/span><\/strong><\/h3>\n
                    \n
                  • \n

                    Non <\/span>fanno <\/span>parte <\/span>dei <\/span>criteri <\/span>diagnostici <\/span>formali, <\/span>ma <\/span>possono <\/span>essere <\/span>presenti.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n

                    [\/vc_column_text][vc_column_text css=””]<\/p>\n

                    Staging (<\/span>non <\/span>ufficiale <\/span>ma <\/span>utilizzato <\/span>nella <\/span>pratica <\/span>clinica)<\/span><\/h2>\n

                    Anche <\/span>se <\/span>i <\/span>criteri <\/span>di <\/span>Boston <\/span>servono <\/span>per <\/span>la <\/span>diagnosi <\/span>probabilistica<\/span><\/strong>, <\/span>alcuni <\/span>autori <\/span>propongono <\/span>una <\/span>valutazione <\/span>semi-<\/span>quantitativa<\/span><\/strong> della <\/span>gravit\u00e0 <\/span>della <\/span>malattia <\/span>in <\/span>base <\/span>a:<\/span><\/p>\n

                      \n
                    • \n

                      Numero <\/span>di <\/span>microemorragie <\/span>lobari:<\/span><\/p>\n

                        \n
                      • \n

                        Lieve: <<\/span>5<\/span><\/p>\n<\/li>\n

                      • \n

                        Moderata: <\/span>5\u2013<\/span>20<\/span><\/p>\n<\/li>\n

                      • \n

                        Grave: ><\/span>20<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n

                      • \n

                        Presenza <\/span>ed <\/span>estensione <\/span>di <\/span>cSS:<\/span><\/p>\n

                          \n
                        • \n

                          Focale (<\/span>1\u2013<\/span>2 <\/span>solchi)<\/span><\/p>\n<\/li>\n

                        • \n

                          Disseminata (><\/span>2 <\/span>solchi <\/span>o <\/span>pi\u00f9 <\/span>lobi)<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                          Questo <\/span>aiuta <\/span>a <\/span>stimare <\/span>il <\/span>rischio <\/span>emorragico<\/span><\/strong> e <\/span>a <\/span>guidare <\/span>decisioni <\/span>terapeutiche, <\/span>es. <\/span>uso <\/span>di <\/span>anticoagulanti.<\/span><\/p>\n

                          [\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

                          [vc_row][vc_column][vc_column_text css=””]I Criteri di Boston (Boston Criteria) sono utilizzati per la diagnosi della angiopatia amiloide cerebrale (CAA), in particolare la forma sporadica che colpisce gli anziani, ed \u00e8 associata a emorragie cerebrali lobari. Nel contesto della risonanza magnetica (RM), i criteri sono fondamentali per definire stadi probabilistici (possibile, probabile) di CAA in assenza di biopsia…<\/p>\n","protected":false},"author":1,"featured_media":76903,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[4],"tags":[],"_links":{"self":[{"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/posts\/76901"}],"collection":[{"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/comments?post=76901"}],"version-history":[{"count":1,"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/posts\/76901\/revisions"}],"predecessor-version":[{"id":76902,"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/posts\/76901\/revisions\/76902"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/media\/76903"}],"wp:attachment":[{"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/media?parent=76901"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/categories?post=76901"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/andreaforneris.com\/web\/wp-json\/wp\/v2\/tags?post=76901"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}