Modified Boston criteria for cerebral amyloid angiopathy (historical)

The Modified Boston criteria were proposed in 2010 in order to incorporate cortical superficial siderosis into the radiological diagnosis of cerebral amyloid angiopathy (CAA) ¹. They comprise of combined clinical, imaging and pathological parameters, and are based upon the original Boston criteria which were proposed in 1995 ². 

The criteria are divided into four tiers and are as ¹:

• definite cerebral amyloid angiopathy:
  • full post-mortem examination reveals lobar, cortical, or cortical/subcortical haemorrhage and pathological evidence of severe cerebral amyloid angiopathy
• probable cerebral amyloid angiopathy with supporting pathological evidence:
  • clinical data and pathological tissue (evacuated haematoma or cortical biopsy specimen) demonstrate a haemorrhage as mentioned above and some degree of vascular amyloid deposition
  • doesn't have to be post-mortem
• probable cerebral amyloid angiopathy:
  • pathological confirmation not required
  • patient 55 years or older
  • appropriate clinical history 
  • MRI findings demonstrate:
    • multiple haemorrhages restricted to lobar, cortical, or corticosubcortical regions (cerebellar haemorrhages allowed) of varying sizes/ages without another cause, or
    • a single lobar, cortical, or corticosubcortical haemorrhage and focal (three of less sulci) or disseminated (more than three sulci) cortical superficial siderosis without another cause
• possible cerebral amyloid angiopathy: 
  • patient 55 years or older
  • appropriate clinical history 
  • MRI findings demonstrate:
    • a single lobar, cortical, or corticosubcortical haemorrhage without another cause, or
    • focal or disseminated cortical superficial siderosis without another cause

The Modified Boston criteria for diagnosis of probable'probable CAA' was pathologically validated in 2010, and compared to the Boston criteria, had an increase in sensitivity (95%, 95% CIconfidence interval (CI) 76% to 99%) with only a modest decrease in specificity (81%, 95% CI 62% to 93%) ^{1, 3}.