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Acta Neurochirurgica

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01-08-2016 | Clinical Article - Neurosurgical Techniques

Fractional anisotropy in patients with disproportionately enlarged subarachnoid space hydrocephalus

Authors: T. Radovnický, D. Adámek, M. Derner, M. Sameš

Published in: Acta Neurochirurgica | Issue 8/2016

Abstract

Background

Disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings on MRI were described as a prognostic factor for responsiveness to the treatment of idiopathic normal pressure hydrocephalus (iNPH). Our premise is that DESH could be associated with compression of the cerebral white matter. Microstructural changes can be identified using diffusion tensor imaging (DTI), specifically fractional anisotropy (FA). The aim of this study is to compare FA in iNPH patients with and without DESH and healthy controls.

Methods

We analysed 1.5-T MRI scans of patients fulfilling the criteria of probable or possible iNPH and positive supplementary tests before and after surgery (ventriculo-peritoneal shunt). FA was measured in the anterior and posterior limb of the internal capsule (PLIC) and in the corpus callosum. Patients were divided into the DESH and non-DESH group. These data were also compared to FA values in the control group.

Results

Twenty-seven patients and 24 healthy controls were enrolled. DESH was present in 15 patients and lacking in 12. Twenty-three iNPH patients were shunt responders (85.2 %), and 4 were non-responders (14.8 %). All patients in the DESH group were shunt responders. In the non-DESH group, eight patients were responders (66.7 %). A significant difference between the DESH and non-DESH group was found in the FA of the PLIC. The mean value of FA in the PLIC was 0.72 in the DESH group and 0.66 in the non-DESH group. After the surgery FA decreased in both groups. In the DESH iNPH group FA PLIC decreased to 0.65 and in the non-DESH iNPH group to 0.60. In the healthy controls, the mean FA in the PLIC was 0.58.

Conclusion

DESH on MRI scans is related to a higher FA in the PLIC with a decrease after the surgery. It reflects a more severe compression of the white matter than in non-DESH patients or healthy volunteers. DESH patients had better outcome than non-DESH patients. This study confirmed the importance of DESH as a supportive sign for iNPH.

Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (1965) Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure. A treatable syndrome. N Engl J Med 273:117–126CrossRefPubMed

Hakim S, Adams RD (1965) The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2(4):307–327CrossRefPubMed

Bergsneider M, Black PM, Klinge P, Marmarou A, Relkin N (2005) Surgical management of idiopathic normal-pressure hydrocephalus. Neurosurgery 57(3 Suppl):S29–39, discussion ii–vPubMed

Klinge P, Marmarou A, Bergsneider M, Relkin N, Black PM (2005) Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients. Neurosurgery 57(3 Suppl):S40–52, discussion ii–vPubMed

Klinge PM, Berding G, Brinker T, Knapp WH, Samii M (1999) A positron emission tomography study of cerebrovascular reserve before and after shunt surgery in patients with idiopathic chronic hydrocephalus. J Neurosurg 91(4):605–609CrossRefPubMed

Momjian S, Owler BK, Czosnyka Z, Czosnyka M, Pena A, Pickard JD (2004) Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus. Brain J Neurol 127(Pt 5):965–972CrossRef

Agren-Wilsson A, Eklund A, Koskinen L-OD, Bergenheim AT, Malm J (2005) Brain energy metabolism and intracranial pressure in idiopathic adult hydrocephalus syndrome. J Neurol Neurosurg Psychiatry 76(8):1088–1093CrossRefPubMedPubMedCentral

Ishikawa M, Kikuchi H, Taki W, Kobayashi A, Nishizawa S, Yonekura Y, Konishi J (1989) Regional cerebral blood flow and oxygen metabolism in normal pressure hydrocephalus after subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 29(5):382–388CrossRef

Wikkelsø C, Hellström P, Klinge PM, Tans JTJ, European iNPH Multicentre Study Group (2013) The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 84(5):562–568CrossRefPubMed

10.

Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T (1998) CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR Am J Neuroradiol 19(7):1277–1284PubMed

11.

Hashimoto M, Ishikawa M, Mori E, Kuwana N, Study of INPH on neurological improvement (SINPHONI) (2010) Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Res 7:18CrossRefPubMedPubMedCentral

12.

Le Bihan D, Turner R, Douek P, Patronas N (1992) Diffusion MR imaging: clinical applications. AJR Am J Roentgenol 159(3):591–599CrossRefPubMed

13.

Masutani Y, Aoki S, Abe O, Hayashi N, Otomo K (2003) MR diffusion tensor imaging: recent advance and new techniques for diffusion tensor visualization. Eur J Radiol 46(1):53–66CrossRefPubMed

14.

Assaf Y, Ben-Sira L, Constantini S, Chang LC, Beni-Adani L (2006) Diffusion tensor imaging in hydrocephalus: initial experience. AJNR Am J Neuroradiol 27(8):1717–1724PubMed

15.

Uluğ AM, Truong TN, Filippi CG, Chun T, Lee JK, Yang C, Souweidane MM, Zimmerman RD (2003) Diffusion imaging in obstructive hydrocephalus. AJNR Am J Neuroradiol 24(6):1171–1176PubMed

16.

Katzman R, Hussey F (1970) A simple constant-infusion manometric test for measurement of CSF absorption. I. Rationale and method. Neurology 20(6):534–544CrossRefPubMed

17.

Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57(3 Suppl):S4–16, discussion ii–vPubMed

18.

Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke J Cereb Circ 19(5):604–607CrossRef

19.

Kiefer M, Eymann R, Komenda Y, Steudel WI (2003) A grading system for chronic hydrocephalus. Zentralblatt Für Neurochir 64(3):109–115CrossRef

20.

Meier U (2002) The grading of normal pressure hydrocephalus. Biomed Tech (Berl) 47(3):54–58CrossRef

21.

Hattingen E, Jurcoane A, Melber J, Blasel S, Zanella FE, Neumann-Haefelin T, Singer OC (2010) Diffusion tensor imaging in patients with adult chronic idiopathic hydrocephalus. Neurosurgery 66(5):917–924CrossRefPubMed

22.

Jurcoane A, Keil F, Szelenyi A, Pfeilschifter W, Singer OC, Hattingen E (2014) Directional diffusion of corticospinal tract supports therapy decisions in idiopathic normal-pressure hydrocephalus. Neuroradiology 56(1):5–13CrossRefPubMed

23.

Koyama T, Marumoto K, Domen K, Miyake H (2013) White matter characteristics of idiopathic normal pressure hydrocephalus: a diffusion tensor tract-based spatial statistic study. Neurol Med Chir (Tokyo) 53(9):601–608CrossRef

24.

Kojoukhova M, Koivisto AM, Korhonen R, Remes AM, Vanninen R, Soininen H, Jääskeläinen JE, Sutela A, Leinonen V (2015) Feasibility of radiological markers in idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 157(10):1709–1718, discussion 1719CrossRef

25.

Virhammar J, Laurell K, Cesarini KG, Larsson E-M (2014) Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol 35(12):2311–2318CrossRefPubMed

26.

Kim MJ, Seo SW, Lee KM, Kim ST, Lee JI, Nam DH, Na DL (2011) Differential diagnosis of idiopathic normal pressure hydrocephalus from other dementias using diffusion tensor imaging. AJNR Am J Neuroradiol 32(8):1496–1503CrossRefPubMed

27.

Hattori T, Yuasa T, Aoki S, Sato R, Sawaura H, Mori T, Mizusawa H (2011) Altered microstructure in corticospinal tract in idiopathic normal pressure hydrocephalus: comparison with Alzheimer disease and Parkinson disease with dementia. AJNR Am J Neuroradiol 32(9):1681–1687CrossRefPubMed

28.

Hattori T, Ito K, Aoki S, Yuasa T, Sato R, Ishikawa M, Sawaura H, Hori M, Mizusawa H (2012) White matter alteration in idiopathic normal pressure hydrocephalus: tract-based spatial statistics study. AJNR Am J Neuroradiol 33(1):97–103CrossRefPubMed

29.

Koyama T, Marumoto K, Domen K, Ohmura T, Miyake H (2012) Diffusion tensor imaging of idiopathic normal pressure hydrocephalus: a voxel-based fractional anisotropy study. Neurol Med Chir (Tokyo) 52(2):68–74CrossRef

Title: Fractional anisotropy in patients with disproportionately enlarged subarachnoid space hydrocephalus
Authors: T. Radovnický
D. Adámek
M. Derner
M. Sameš
Publication date: 01-08-2016
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 8/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-016-2861-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Fractional anisotropy in patients with disproportionately enlarged subarachnoid space hydrocephalus

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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