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Lee S, Lim JS, Cheong EN, Lee Y, Kim JW, Kim YE, Jo S, Kim HJ, Shim WH, Lee JH. Relationship between disproportionately enlarged subarachnoid-space hydrocephalus and white matter tract integrity in normal pressure hydrocephalus. Sci Rep 2023; 13:21328. [PMID: 38044360 PMCID: PMC10694135 DOI: 10.1038/s41598-023-48940-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/01/2023] [Indexed: 12/05/2023] Open
Abstract
Normal pressure hydrocephalus (NPH) patients had altered white matter tract integrities on diffusion tensor imaging (DTI). Previous studies suggested disproportionately enlarged subarachnoid space hydrocephalus (DESH) as a prognostic sign of NPH. We examined DTI indices in NPH subgroups by DESH severity and clinical symptoms. This retrospective case-control study included 33 NPH patients and 33 age-, sex-, and education-matched controls. The NPH grading scales (0-12) were used to rate neurological symptoms. Patients with NPH were categorized into two subgroups, high-DESH and low-DESH groups, by the average value of the DESH scale. DTI indices, including fractional anisotropy, were compared across 14 regions of interest (ROIs). The high-DESH group had increased axial diffusivity in the lateral side of corona radiata (1.43 ± 0.25 vs. 1.72 ± 0.25, p = 0.04), and showed decreased fractional anisotropy and increased mean, and radial diffusivity in the anterior and lateral sides of corona radiata and the periventricular white matter surrounding the anterior horn of lateral ventricle. In patients with a high NPH grading scale, fractional anisotropy in the white matter surrounding the anterior horn of the lateral ventricle was significantly reduced (0.36 ± 0.08 vs. 0.26 ± 0.06, p = 0.03). These data show that DESH may be a biomarker for DTI-detected microstructural alterations and clinical symptom severity.
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Affiliation(s)
- Sunju Lee
- Department of Neurology, Seosan Jungang General Hospital, Seosan-si, Chungcheongnam-do, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Sonpa-gu, Seoul, 05505, Republic of Korea
| | - E-Nae Cheong
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoojin Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Sonpa-gu, Seoul, 05505, Republic of Korea
| | - Jae Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Sonpa-gu, Seoul, 05505, Republic of Korea
| | - Ye Eun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Sonpa-gu, Seoul, 05505, Republic of Korea
| | - Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Sonpa-gu, Seoul, 05505, Republic of Korea
| | - Hyung-Ji Kim
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Woo Hyun Shim
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Sonpa-gu, Seoul, 05505, Republic of Korea.
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Sedlák V, Bubeníková A, Skalický P, Vlasák A, Whitley H, Netuka D, Beneš V, Beneš V, Bradáč O. Diffusion tensor imaging helps identify shunt-responsive normal pressure hydrocephalus patients among probable iNPH cohort. Neurosurg Rev 2023; 46:173. [PMID: 37442856 PMCID: PMC10344981 DOI: 10.1007/s10143-023-02078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to investigate whether white matter changes as measured by diffusion tensor imaging (DTI) can help differentiate shunt-responsive idiopathic normal pressure hydrocephalus (iNPH) patients from patients with other causes of gait disturbances and/or cognitive decline with ventriculomegaly whose clinical symptoms do not improve significantly after cerebrospinal fluid derivation (non-iNPH). Between 2017 and 2022, 85 patients with probable iNPH underwent prospective preoperative magnetic resonance imaging (MRI) and comprehensive clinical workup. Patients with clinical symptoms of iNPH, positive result on lumbar infusion test, and gait improvement after 120-h lumbar drainage were diagnosed with iNPH and underwent shunt-placement surgery. Fractional anisotropy (FA) and mean diffusivity (MD) values for individual regions of interest were extracted from preoperative MRI, using the TBSS pipeline of FSL toolkit. These FA and MD values were then compared to results of clinical workup and established diagnosis of iNPH. An identical MRI protocol was performed on 13 age- and sex-matched healthy volunteers. Statistically significant differences in FA values of several white matter structures were found not only between iNPH patients and healthy controls but also between iNPH and non-iNPH patients. ROI that showed best diagnostic ability when differentiating iNPH among probable iNPH cohort was uncinate fasciculus, with AUC of 0.74 (p < 0.001). DTI methods of white matter analysis using standardised methods of ROI extraction can help in differentiation of iNPH patients not only from healthy patients but also from patients with other causes of gait disturbances with cognitive decline and ventriculomegaly.
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Affiliation(s)
- Vojtěch Sedlák
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Adéla Bubeníková
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - Petr Skalický
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Aleš Vlasák
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Helen Whitley
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Yin R, Wen J, Wei J. Progression in Neuroimaging of Normal Pressure Hydrocephalus. Front Neurol 2021; 12:700269. [PMID: 34867705 PMCID: PMC8636440 DOI: 10.3389/fneur.2021.700269] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Normal-pressure hydrocephalus is a clinical syndrome that mainly targets the elderly population. It features dementia, impaired walking, and the malfunction of sphincters. The rapid identification and large-scale screening of patients with normal-pressure hydrocephalus (NPH) are of great significance as surgical interventions can greatly improve or even reverse the symptoms. This review aims to summarize the traditional parameters used to diagnose NPH and the emerging progression in neuroimaging of the disease, hoping to provide an up-to-date overall perspective and summarize the possible direction of its future development.
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Affiliation(s)
- Rui Yin
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junxian Wen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Sarica A, Quattrone A, Mechelli A, Vaccaro MG, Morelli M, Quattrone A. Corticospinal tract abnormalities and ventricular dilatation: A transdiagnostic comparative tractography study. NEUROIMAGE-CLINICAL 2021; 32:102862. [PMID: 34688144 PMCID: PMC8536776 DOI: 10.1016/j.nicl.2021.102862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/30/2021] [Accepted: 10/18/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Microstructural alterations of corticospinal tract (CST) have been found in idiopathic normal pressure hydrocephalus (iNPH). No study, however, investigated the effect of ventricular dilatation on CST in Progressive Supranuclear Palsy (PSP). OBJECTIVE The aim of this study was to investigate CST diffusion profile in a large cohort of PSP patients with and without ventricular dilatation. METHODS Twenty-three iNPH patients, 87 PSP patients and 26 controls were enrolled. Evans index (EI) and ventricular volume (VV) were measured in all patients. CST tractography was performed to calculate FA, MD, AxD and RD in six different anatomical regions: medulla oblungata (MO), pons (P), cerebral peduncle (CP), posterior limb of internal capsule (PLIC), corona radiata (CR), subcortical white matter (SWM). ANCOVA was used for comparing CST diffusion profiles between the groups and association between CST microstructural metrics and measures of ventricular dilatation (EI and VV) was assessed. RESULTS Thirty-three PSP patients had ventricular dilatation (EI > 0.30, PSP-vd) while 54 PSP patients had normal ventricular system (EI ≤ 0.30, PSP-wvd). iNPH patients had the most marked FA and AxD increase in PLIC and CR of CST followed by PSP-vd, PSP-wvd and controls; RD was altered only in iNPH. A strong correlation was found between CST diffusion metrics and EI or VV. CONCLUSIONS Our findings confirm the microstructural changes of CST in iNPH patients and demonstrate for the first time similar alterations in PSP-vd patients, suggesting a crucial role of ventricular dilatation in the mechanical compression of CST.
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Affiliation(s)
- Alessia Sarica
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alessandro Mechelli
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Maria Grazia Vaccaro
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Maurizio Morelli
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, 88100 Catanzaro, Italy.
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Grazzini I, Venezia D, Cuneo GL. The role of diffusion tensor imaging in idiopathic normal pressure hydrocephalus: A literature review. Neuroradiol J 2021; 34:55-69. [PMID: 33263494 PMCID: PMC8041402 DOI: 10.1177/1971400920975153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome that comprises a triad of gait disturbance, dementia and urinary incontinence, associated with ventriculomegaly in the absence of elevated intraventricular cerebrospinal fluid (CSF) pressure. It is important to identify patients with iNPH because some of its clinical features may be reversed by the insertion of a CSF shunt. The diagnosis is based on clinical history, physical examination and brain imaging, especially magnetic resonance imaging (MRI). Recently, some papers have investigated the role of diffusion tensor imaging (DTI) in evaluating white matter alterations in patients with iNPH. DTI analysis in specific anatomical regions seems to be a promising MR biomarker of iNPH and could also be used in the differential diagnosis from other dementias. However, there is a substantial lack of structured reviews on this topic. Thus, we performed a literature search and analyzed the most recent and pivotal articles that investigated the role of DTI in iNPH in order to provide an up-to-date overview of the application of DTI in this setting. We reviewed studies published between January 2000 and June 2020. Thirty-eight studies and four reviews were included. Despite heterogeneity in analysis approaches, the majority of studies reported significant correlations between DTI and clinical symptoms in iNPH patients, as well as different DTI patterns in patients with iNPH compared to those with Alzheimer or Parkinson diseases. It remains to be determined whether DTI could predict the success after CSF shunting.
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Affiliation(s)
- Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Duccio Venezia
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
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NAKAJIMA M, YAMADA S, MIYAJIMA M, ISHII K, KURIYAMA N, KAZUI H, KANEMOTO H, SUEHIRO T, YOSHIYAMA K, KAMEDA M, KAJIMOTO Y, MASE M, MURAI H, KITA D, KIMURA T, SAMEJIMA N, TOKUDA T, KAIJIMA M, AKIBA C, KAWAMURA K, ATSUCHI M, HIRATA Y, MATSUMAE M, SASAKI M, YAMASHITA F, AOKI S, IRIE R, MIYAKE H, KATO T, MORI E, ISHIKAWA M, DATE I, ARAI H. Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus. Neurol Med Chir (Tokyo) 2021; 61:63-97. [PMID: 33455998 PMCID: PMC7905302 DOI: 10.2176/nmc.st.2020-0292] [Citation(s) in RCA: 190] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/13/2020] [Indexed: 01/18/2023] Open
Abstract
Among the various disorders that manifest with gait disturbance, cognitive impairment, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. The first edition of these guidelines for management of iNPH was published in 2004, and the second edition in 2012, to provide a series of timely, evidence-based recommendations related to iNPH. Since the last edition, clinical awareness of iNPH has risen dramatically, and clinical and basic research efforts on iNPH have increased significantly. This third edition of the guidelines was made to share these ideas with the international community and to promote international research on iNPH. The revision of the guidelines was undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project. This revision proposes a new classification for NPH. The category of iNPH is clearly distinguished from NPH with congenital/developmental and acquired etiologies. Additionally, the essential role of disproportionately enlarged subarachnoid-space hydrocephalus (DESH) in the imaging diagnosis and decision for further management of iNPH is discussed in this edition. We created an algorithm for diagnosis and decision for shunt management. Diagnosis by biomarkers that distinguish prognosis has been also initiated. Therefore, diagnosis and treatment of iNPH have entered a new phase. We hope that this third edition of the guidelines will help patients, their families, and healthcare professionals involved in treating iNPH.
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Affiliation(s)
- Madoka NAKAJIMA
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shigeki YAMADA
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Shiga, Japan
| | - Masakazu MIYAJIMA
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kazunari ISHII
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Nagato KURIYAMA
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan
| | - Hiroaki KAZUI
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hideki KANEMOTO
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi SUEHIRO
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kenji YOSHIYAMA
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masahiro KAMEDA
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Yoshinaga KAJIMOTO
- Department of Neurosurgery, Division of Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Mitsuhito MASE
- Department of Neurosurgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hisayuki MURAI
- Department of Neurosurgery, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, Japan
| | - Daisuke KITA
- Department of Neurosurgery, Noto General Hospital, Nanao, Ishikawa, Japan
| | - Teruo KIMURA
- Department of Neurosurgery, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan
| | - Naoyuki SAMEJIMA
- Department of Neurosurgery, Tokyo Kyosai Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
| | - Takahiko TOKUDA
- Department of Functional Brain Imaging Research, National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Chiba, Japan
| | - Mitsunobu KAIJIMA
- Department of Neurosurgery, Hokushinkai Megumino Hospital, Eniwa, Hokkaido, Japan
| | - Chihiro AKIBA
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kaito KAWAMURA
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masamichi ATSUCHI
- Normal Pressure Hydrocephalus Center, Jifukai Atsuchi Neurosurgical Hospital, Kagoshima, Kagoshima, Japan
| | - Yoshihumi HIRATA
- Department of Neurosurgery, Kumamoto Takumadai Hospital, Kumamoto, Kumamoto, Japan
| | - Mitsunori MATSUMAE
- Department of Neurosurgery at Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Makoto SASAKI
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Iwate, Japan
| | - Fumio YAMASHITA
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Iwate, Japan
| | - Shigeki AOKI
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryusuke IRIE
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroji MIYAKE
- Nishinomiya Kyoritsu Rehabilitation Hospital, Nishinomiya, Hyogo, Japan
| | - Takeo KATO
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata, Yamagata, Japan
| | - Etsuro MORI
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Osaka, Japan
| | - Masatsune ISHIKAWA
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Kyoto, Japan
| | - Isao DATE
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Hajime ARAI
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - The research committee of idiopathic normal pressure hydrocephalus
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Shiga, Japan
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Kyoto, Japan
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
- Department of Neurosurgery, Division of Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
- Department of Neurosurgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Aichi, Japan
- Department of Neurosurgery, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, Japan
- Department of Neurosurgery, Noto General Hospital, Nanao, Ishikawa, Japan
- Department of Neurosurgery, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan
- Department of Neurosurgery, Tokyo Kyosai Hospital, Federation of National Public Service Personnel Mutual Aid Associations, Tokyo, Japan
- Department of Functional Brain Imaging Research, National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Chiba, Japan
- Department of Neurosurgery, Hokushinkai Megumino Hospital, Eniwa, Hokkaido, Japan
- Normal Pressure Hydrocephalus Center, Jifukai Atsuchi Neurosurgical Hospital, Kagoshima, Kagoshima, Japan
- Department of Neurosurgery, Kumamoto Takumadai Hospital, Kumamoto, Kumamoto, Japan
- Department of Neurosurgery at Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Iwate, Japan
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
- Nishinomiya Kyoritsu Rehabilitation Hospital, Nishinomiya, Hyogo, Japan
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata, Yamagata, Japan
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Osaka, Japan
- Department of Neurosurgery and Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Kyoto, Japan
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Indication of Thalamo-Cortical Circuit Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Tensor Imaging Study. Sci Rep 2020; 10:6148. [PMID: 32273554 PMCID: PMC7145806 DOI: 10.1038/s41598-020-63238-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/19/2020] [Indexed: 11/29/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a disorder with unclear pathophysiology. The diagnosis of iNPH is challenging due to its radiological similarity with other neurodegenerative diseases and ischemic subcortical white matter changes. By using Diffusion Tensor Imaging (DTI) we explored differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in iNPH patients (before and after a shunt surgery) and healthy individuals (HI) and we correlated the clinical results with DTI parameters. Thirteen consecutive iNPH-patients underwent a pre- and post-operative clinical work-up: 10 m walk time (w10mt) steps (w10ms), TUG-time (TUGt) and steps (TUGs); for cognitive function MMSE. Nine HI were included. DTI was performed before and 3 months after surgery, HI underwent DTI once. DTI differences analyzed by manually placing 12 regions-of-interest. In patients motor and balance function improved significantly after surgery (p = 0.01, p = 0.025). Higher nearly significant FA values found in the patients vs HI pre-operatively in the thalamus (p = 0.07) accompanied by an almost significant lower ADC (p = 0.08). Significantly FA and ADC-values were found between patients and HI in FWM (p = 0.02, p = 0.001) and almost significant (p = 0.057) pre- vs postoperatively. Postoperatively we found a trend towards the HIs FA values and a strong significant negative correlation between FA changes vs. gait results in the FWM (r = −0.7, p = 0.008). Our study gives a clear indication of an ongoing pathological process in the periventricular white matter, especially in the thalamus and in the frontal white matter supporting the hypothesis of a shunt reversible thalamo-cortical circuit dysfunction in iNPH.
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Injury of Corticospinal Tract in a Patient with Subarachnoid Hemorrhage as Determined by Diffusion Tensor Tractography: A Case Report. Brain Sci 2020; 10:brainsci10030177. [PMID: 32204357 PMCID: PMC7139640 DOI: 10.3390/brainsci10030177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022] Open
Abstract
We report diffusion tensor tractography (DTT) of the corticospinal tract (CST) in a patient with paresis of all four limbs following subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) after the rupture of an anterior communicating artery (ACoA) aneurysm rupture. The 73-year-old female was admitted to our emergency room in a semi-comatose mental state. After coil embolization-an acute SAH treatment-she was transferred to our rehabilitation department with motor weakness development, two weeks after SAH. Upon admission, she was alert but she complained of motor weakness (upper limbs: MRC 3/5, and lower limbs: MRC 1/5). Four weeks after onset, DTT showed that the bilateral CSTs failed to reach the cerebral cortex. The left CST demonstrated a wide spread of fibers within the corona radiata as well as significantly lower tract volume (TV) and higher fractional anisotropy (FA) as well as mean diffusivity (MD) compared to the controls. On the other hand, the right CST shifted to the posterior region at the corona radiata, and MD values of the right CST were significantly higher when compared to the controls. Changes in both CSTs were attributed to vasogenic edema and compression caused by untreated hydrocephalus. We demonstrate in this case, two different pathophysiological entitles, contributing to this patient's motor weakness after SAH.
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Griffa A, Van De Ville D, Herrmann FR, Allali G. Neural circuits of idiopathic Normal Pressure Hydrocephalus: A perspective review of brain connectivity and symptoms meta-analysis. Neurosci Biobehav Rev 2020; 112:452-471. [PMID: 32088348 DOI: 10.1016/j.neubiorev.2020.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent reversible neurological disorder characterized by impaired locomotion, cognition and urinary control with ventriculomegaly. Symptoms can be relieved with cerebrospinal fluid drainage, which makes iNPH the leading cause of reversible dementia. Because of a limited understanding of pathophysiological mechanisms, unspecific symptoms and the high prevalence of comorbidity (i.e. Alzheimer's disease), iNPH is largely underdiagnosed. For these reasons, there is an urgent need for developing noninvasive quantitative biomarkers for iNPH diagnosis and prognosis. Structural and functional changes of brain circuits in relation to symptoms and treatment response are expected to deliver major advances in this direction. We review structural and functional brain connectivity findings in iNPH and complement those findings with iNPH symptom meta-analyses in healthy populations. Our goal is to reinforce our conceptualization of iNPH as to brain network mechanisms and foster the development of new hypotheses for future research and treatment options.
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Affiliation(s)
- Alessandra Griffa
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Lausanne, Switzerland.
| | - Dimitri Van De Ville
- Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Lausanne, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
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Normal Pressure Hydrocephalus: Clinical Symptoms, Cerebrospinal Fluid Flow Metrics and White Matter Changes. J Comput Assist Tomogr 2020; 44:59-64. [PMID: 31939883 DOI: 10.1097/rct.0000000000000959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to investigate correlations between clinical symptoms, cerebrospinal fluid flow metrics, hydrocephalus index, small-vessel disease, and white matter (WM) changes in normal pressure hydrocephalus (NPH). METHODS Aquaductal stroke volumes (ASVs), Z Evans index, Fazekas grading (FG), and diffusion tensor imaging measurements from WM bundles of 37 patients with NPH were retrospectively evaluated. Mann-Whitney U test between clinical symptoms and other variables and Spearman ρ correlations for relationships between variables and Kruskal-Wallis to correlate FG with nonclinical variables were used. RESULTS Patients with NPH had increased ASV (median 53 μL). No correlation was found between Z Evans index and ASV. Three groups of patients with dementia or ataxia or incontinence had increased ASV values than their counterparts without symptoms (55 vs 48.5 μL, 75 vs 47 μL, 64 vs 49.5 μL, respectively). Patients having 2 common symptoms of dementia and ataxia and patients having all 3 symptoms of dementia, ataxia, and incontinence were compared with ASV values of 63.5 versus 78 μL, respectively. Patients with FG 1 had median ASV values of 45 μL; FG 2, 82.5 μL; and FG 3, 59 μL. Patients with dementia had significantly higher apparent diffusion coefficient (ADC) values of corona radiata (CR) on both sides. There were no significant WM changes in patients with ataxia and incontinence. The Z Evans index was positively correlated with ADC values of CR on both sides and genu of corpus callosum. Fazekas grading was found positively correlated with ADC and negatively correlated with FA values of CR. CONCLUSIONS Patients with NPH, regardless of stages of the diseases, have increased ASV values and could benefit from shunting. Decreasing ASV values of patients with FG 3 comparing with those with FG 2 support the hypothesis of decreasing compliance of brain with aging and increasing severity of small-vessel disease.
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Saito A, Kamagata K, Ueda R, Nakazawa M, Andica C, Irie R, Nakajima M, Miyajima M, Hori M, Tanaka F, Arai H, Aoki S. Ventricular volumetry and free-water corrected diffusion tensor imaging of the anterior thalamic radiation in idiopathic normal pressure hydrocephalus. J Neuroradiol 2019; 47:312-317. [PMID: 31034894 DOI: 10.1016/j.neurad.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 03/06/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE The pathophysiology of idiopathic normal pressure hydrocephalus (iNPH) has not been completely clarified. We investigated the brain structure in iNPH using automatic ventricular volumetry, single-tensor diffusion tensor imaging (DTI) and bi-tensor free-water (FW) imaging analyses while focusing on cognitive impairments before and after lumboperitoneal shunt surgery. MATERIALS AND METHODS This retrospective study included 12 iNPH patients with structural magnetic resonance imaging (MRI) and diffusion MRI (dMRI) on a 3T-MRI scanner who underwent neuropsychological assessments before and after shunting and 8 healthy controls. Ventricular volumetry was conducted on structural MRI datasets using FreeSurfer. Ventricular volume was compared pre- and postoperatively. Correlation analyses were performed between ventricular volume or volume change and neuropsychological scores or score change. Tract-based spatial statistics were performed using dMRI datasets for group analyses between iNPH and controls and between pre- and post-surgery iNPH patients and for correlation analyses using neuropsychological scores. Tract-specific analyses were performed in the anterior thalamic radiation (ATR), followed by comparison and correlation analyses. RESULTS The third ventricular volume was significantly decreased after shunting; its volume reduction negatively correlated with a neuropsychological improvement. Compared with controls, iNPH patients had lower fractional anisotropy and higher axial, radial, and mean diffusivities, and FW in the periventricular white matter including ATR, resulting in no difference in FW-corrected indices. Single-tensor DTI indices partially correlated with neuropsychological improvements, while FW-corrected indices had no correlations. CONCLUSION Third ventricle enlargement is possibly linked to cognitive impairment and FW imaging possibly provides better white matter characterization in iNPH.
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Affiliation(s)
- Asami Saito
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ryo Ueda
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Misaki Nakazawa
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Christina Andica
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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12
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Ades-Aron B, Yeager S, Miskin N, Fieremans E, George A, Golomb J. Diffusional Kurtosis along the Corticospinal Tract in Adult Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2018; 39:2218-2223. [PMID: 30385473 DOI: 10.3174/ajnr.a5845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Normal Pressure Hydrocephalus is a reversible form of dementia characterized by enlarged ventricles, which can deform and cause disruptions to adjacent white matter fibers. The purpose of this work was to examine how diffusion and kurtosis parameters vary along the corticospinal tract and determine where along this path microstructure is compromised in patients diagnosed with normal pressure hydrocephalus. We hypothesized that disruption of the corticospinal tract from ventricular enlargement can be measured using diffusion MR imaging and this will be quantified in periventricular regions. MATERIALS AND METHODS We developed a method to analyze diffusion parameters at discrete points along neural tracts. We then used diffusion MR imaging data from patients with Alzheimer disease and healthy controls to compare whether diffusion along the corticospinal tract differs from that of patients with normal pressure hydrocephalus. RESULTS We found that diffusion parameters can differentiate patients with normal pressure hydrocephalus from those with Alzheimer disease and healthy controls: Axial diffusion, axial kurtosis, and the axonal water fraction were found to differ significantly across groups (P < .05) in an area located close to the superior internal capsule and corona radiata but below the cortex. CONCLUSIONS A lower axonal water fraction indicates a lower axonal density in the corticospinal tract, which may indicate permanent damage. Lower axial kurtosis may imply that axons are being more aligned due to compression.
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Affiliation(s)
- B Ades-Aron
- From the Center for Biomedical Imaging (B.A.-A., S.Y., E.F., A.G.), Department of Radiology
| | - S Yeager
- From the Center for Biomedical Imaging (B.A.-A., S.Y., E.F., A.G.), Department of Radiology
| | - N Miskin
- Department of Radiology (N.M.), Brigham and Women's Hospital, Boston, Massachusetts
| | - E Fieremans
- From the Center for Biomedical Imaging (B.A.-A., S.Y., E.F., A.G.), Department of Radiology
| | - A George
- From the Center for Biomedical Imaging (B.A.-A., S.Y., E.F., A.G.), Department of Radiology
| | - J Golomb
- Department of Neurology (J.G.), New York University School of Medicine, New York, New York
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Diagnostic Performance of Monoexponential DWI Versus Diffusion Kurtosis Imaging in Prostate Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:358-368. [PMID: 29812977 DOI: 10.2214/ajr.17.18934] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We aimed to compare the diagnostic performance of monoexponential DWI and diffusion kurtosis imaging (DKI) for the detection of prostate cancer (PCa). MATERIALS AND METHODS A systematic literature search was conducted for studies evaluating the diagnostic value of monoexponential DWI and DKI for PCa in the same patient cohorts with sufficient data to construct 2 × 2 contingency tables. Qualities of the included studies were assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data were extracted to calculate pooled sensitivities and specificities. We constructed summary ROC curves and calculated AUCs to determine the performances of DKI parameters (diffusion coefficient and kurtosis characterizing the deviation from the monoexponential decay) and apparent diffusion coefficient (ADC) values in diagnosing PCa. RESULTS Five studies (463 patients) were included, with eight, nine, and 10 subsets of data available for analysis of ADC, diffusion, and kurtosis, respectively. Pooled sensitivities were 89% (95% CI, 80-94%) for ADC, 91% (95% CI, 84-95%) for diffusion, and 87% (95% CI, 83-91%) for kurtosis. Pooled specificities were 86% (95% CI, 80-90%) for ADC, 78% (95% CI, 71-84%) for diffusion, and 85% (95% CI, 81-89%) for kurtosis. According to the summary ROC analyses, the AUC was 0.93 (95% CI, 0.90-0.95) for ADC, 0.89 (95% CI, 0.86-0.92) for diffusion, and 0.93 (95% CI, 0.90-0.95) for kurtosis. There was no notable publication bias, but significant heterogeneity was observed. CONCLUSION Monoexponential DWI and DKI showed comparable diagnostic accuracies for PCa. DKI is a potentially helpful method for the diagnosis of PCa. Therefore, on the basis of current evidence, we do not recommend including DKI in routine clinical assessment of PCa for the moment.
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Irie R, Kamagata K, Kerever A, Ueda R, Yokosawa S, Otake Y, Ochi H, Yoshizawa H, Hayashi A, Tagawa K, Okazawa H, Takahashi K, Sato K, Hori M, Arikawa-Hirasawa E, Aoki S. The Relationship between Neurite Density Measured with Confocal Microscopy in a Cleared Mouse Brain and Metrics Obtained from Diffusion Tensor and Diffusion Kurtosis Imaging. Magn Reson Med Sci 2017; 17:138-144. [PMID: 29213008 PMCID: PMC5891339 DOI: 10.2463/mrms.mp.2017-0031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: Diffusional kurtosis imaging (DKI) enables sensitive measurement of tissue microstructure by quantifying the non-Gaussian diffusion of water. Although DKI is widely applied in many situations, histological correlation with DKI analysis is lacking. The purpose of this study was to determine the relationship between DKI metrics and neurite density measured using confocal microscopy of a cleared mouse brain. Methods: One thy-1 yellow fluorescent protein 16 mouse was deeply anesthetized and perfusion fixation was performed. The brain was carefully dissected out and whole-brain MRI was performed using a 7T animal MRI system. DKI and diffusion tensor imaging (DTI) data were obtained. After the MRI scan, brain sections were prepared and then cleared using aminoalcohols (CUBIC). Confocal microscopy was performed using a two-photon confocal microscope with a laser. Forty-eight ROIs were set on the caudate putamen, seven ROIs on the anterior commissure, and seven ROIs on the ventral hippocampal commissure on the confocal microscopic image and a corresponding MR image. In each ROI, histological neurite density and the metrics of DKI and DTI were calculated. The correlations between diffusion metrics and neurite density were analyzed using Pearson correlation coefficient analysis. Results: Mean kurtosis (MK) (P = 5.2 × 10−9, r = 0.73) and radial kurtosis (P = 2.3 × 10−9, r = 0.74) strongly correlated with neurite density in the caudate putamen. The correlation between fractional anisotropy (FA) and neurite density was moderate (P = 0.0030, r = 0.42). In the anterior commissure and the ventral hippocampal commissure, neurite density and FA are very strongly correlated (P = 1.3 × 10−5, r = 0.90). MK in these areas were very high value and showed no significant correlation (P = 0.48). Conclusion: DKI accurately reflected neurite density in the area with crossing fibers, potentially allowing evaluation of complex microstructures.
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Affiliation(s)
- Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, The University of Tokyo Graduate School of Medicine
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine
| | - Aurelien Kerever
- Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine
| | - Ryo Ueda
- Department of Radiological Sciences, Tokyo Metropolitan University Graduate School of Human Health Sciences
| | | | | | | | - Hidekazu Yoshizawa
- Department of Plastic and Reconstructive Surgery, Juntendo University Graduate School of Medicine
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital
| | - Kazuhiko Tagawa
- Department of Neuropathology, Tokyo Medical and Dental University
| | - Hitoshi Okazawa
- Department of Neuropathology, Tokyo Medical and Dental University
| | - Kohske Takahashi
- Department of Psychology, Chukyo University.,Araya Brain Imaging
| | - Kanako Sato
- Department of Radiology, Juntendo University School of Medicine
| | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine
| | - Eri Arikawa-Hirasawa
- Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine
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15
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Li D, Wang X. Diffusion Kurtosis Imaging and Pathology in Spinal Cord Ischemia/Reperfusion Injury in Rabbits: A Case-Control Study. Med Sci Monit 2017; 23:3996-4003. [PMID: 28820864 PMCID: PMC5572784 DOI: 10.12659/msm.902986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to evaluate the application of diffusion kurtosis imaging (DKI) in spinal cord ischemia/reperfusion (SCI/R) injury and to explore its association with pathology. Material/Methods Japanese male long-eared rabbits were chosen and divided into 7 groups (8 rabbits in each group): control group (C group), sham-operation control group (S group), and 5 experimental groups (E-2 h group, E-24 h group, E-48 h group, E-7 d group, and E-14 d group). Tarlov scoring and immunohistochemical staining were used to assess hindlimb motor function and observe the expression of glial fiber acidic protein (GFAP), respectively. The correlation between DKI and pathology after SCI/R injury was compared by 3.0TMR scanning DKI. Result Neuroethology in each time point of E groups was significantly different from that in C and S groups (P<0.05). The E-24 h group had the lowest value (P<0.05), and the hindlimb motor function began to recover after 24 h. The expression of GFAP was gradually increased after SCI/R injury, and the maximum value was in the E-7 d group (P<0.05). MK (mean kurtosis) had a linear negative correlation with average optical density (OD) (r=−0.115, P<0.05) and was positively correlated with integral OD (IOD) (r=0.204, P<0.05), in which MD (mean dispersion) was positively correlated with OD and IOD, but without a significant difference (r=0.618, r=251, P>0.05). Conclusions DKI can be used to monitor the changes in SCI/R injury, and fractional anisotropy (FA) can reflect change in white matter structure. The changes in expression of MK and GFAP were related to the myelin sheath injury repair process.
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Affiliation(s)
- Daowei Li
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Department of Radiology, The People's Hospital of China Medical University and The People's Hospital of Liaoning Province, Shenyang, Liaoning, China (mainland)
| | - Xiaoming Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
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Martín Noguerol T, Martínez Barbero J. Advanced diffusion MRI and biomarkers in the central nervous system: A new approach. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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17
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Martín Noguerol T, Martínez Barbero JP. Advanced diffusion MRI and biomarkers in the central nervous system: a new approach. RADIOLOGIA 2017; 59:273-285. [PMID: 28552216 DOI: 10.1016/j.rx.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/13/2017] [Accepted: 04/16/2017] [Indexed: 01/08/2023]
Abstract
The introduction of diffusion-weighted sequences has revolutionized the detection and characterization of central nervous system (CNS) disease. Nevertheless, the assessment of diffusion studies of the CNS is often limited to qualitative estimation. Moreover, the pathophysiological complexity of the different entities that affect the CNS cannot always be correctly explained through classical models. The development of new models for the analysis of diffusion sequences provides numerous parameters that enable a quantitative approach to both diagnosis and prognosis as well as to monitoring the response to treatment; these parameters can be considered potential biomarkers of health and disease. In this update, we review the physical bases underlying diffusion studies and diffusion tensor imaging, advanced models for their analysis (intravoxel coherent motion and kurtosis), and the biological significance of the parameters derived.
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Affiliation(s)
- T Martín Noguerol
- Sección de Neurorradiología. Clínica las Nieves. SERCOSA. Grupo HealthTime, Jaén, España.
| | - J P Martínez Barbero
- Sección de Neurorradiología. Clínica las Nieves. SERCOSA. Grupo HealthTime, Jaén, España
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18
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Li D, Wang X. Application value of diffusional kurtosis imaging (DKI) in evaluating microstructural changes in the spinal cord of patients with early cervical spondylotic myelopathy. Clin Neurol Neurosurg 2017; 156:71-76. [DOI: 10.1016/j.clineuro.2017.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/13/2017] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
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Kamiya K, Hori M, Irie R, Miyajima M, Nakajima M, Kamagata K, Tsuruta K, Saito A, Nakazawa M, Suzuki Y, Mori H, Kunimatsu A, Arai H, Aoki S, Abe O. Diffusion imaging of reversible and irreversible microstructural changes within the corticospinal tract in idiopathic normal pressure hydrocephalus. NEUROIMAGE-CLINICAL 2017; 14:663-671. [PMID: 28348958 PMCID: PMC5358533 DOI: 10.1016/j.nicl.2017.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/05/2017] [Accepted: 03/10/2017] [Indexed: 11/05/2022]
Abstract
The symptoms of idiopathic normal pressure hydrocephalus (iNPH) can be improved by shunt surgery, but prediction of treatment outcome is not established. We investigated changes of the corticospinal tract (CST) in iNPH before and after shunt surgery by using diffusion microstructural imaging, which infers more specific tissue properties than conventional diffusion tensor imaging. Two biophysical models were used: neurite orientation dispersion and density imaging (NODDI) and white matter tract integrity (WMTI). In both methods, the orientational coherence within the CSTs was higher in patients than in controls, and some normalization occurred after the surgery in patients, indicating axon stretching and recovery. The estimated axon density was lower in patients than in controls but remained unchanged after the surgery, suggesting its potential as a marker for irreversible neuronal damage. In a Monte-Carlo simulation that represented model axons as undulating cylinders, both NODDI and WMTI separated the effects of axon density and undulation. Thus, diffusion MRI may distinguish between reversible and irreversible microstructural changes in iNPH. Our findings constitute a step towards a quantitative image biomarker that reflects pathological process and treatment outcomes of iNPH. NODDI and WMTI provide markers of reversible and irreversible changes in iNPH. Measures of axon orientation indicated recovery from stretching after surgery. Axon density remained low after surgery, suggesting chronic neuronal damage. Axon stretching in simulations differentially affected diffusion metrics.
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Key Words
- AD, axial diffusivity
- AWF, axonal water fraction
- Axon density
- Axon undulation
- CSF, cerebrospinal fluid
- CST, corticospinal tract
- DTI, diffusion tensor imaging
- Diffusion MRI
- FA, fractional anisotropy
- Idiopathic normal pressure hydrocephalus
- MD, mean diffusivity
- NODDI, neurite orientation dispersion and density imaging
- ODI, orientation dispersion index
- RD, radial diffusivity
- ROI, region of interest
- VF, volume fraction
- VOI, volume of interest
- WMTI, white matter tract integrity
- iNPH, idiopathic normal pressure hydrocephalus
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Affiliation(s)
- Kouhei Kamiya
- Department of Radiology, The University of Tokyo, Bunkyo, Tokyo, Japan; Department of Radiology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Ryusuke Irie
- Department of Radiology, The University of Tokyo, Bunkyo, Tokyo, Japan; Department of Radiology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Kouhei Tsuruta
- Department of Radiology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Asami Saito
- Department of Radiology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Misaki Nakazawa
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa, Tokyo, Japan
| | - Yuichi Suzuki
- Department of Radiology, The University of Tokyo Hospital, Bunkyo, Tokyo, Japan
| | - Harushi Mori
- Department of Radiology, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Akira Kunimatsu
- Department of Radiology, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, The University of Tokyo, Bunkyo, Tokyo, Japan
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Hydrocephalus after Subarachnoid Hemorrhage: Pathophysiology, Diagnosis, and Treatment. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8584753. [PMID: 28373987 PMCID: PMC5360938 DOI: 10.1155/2017/8584753] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/01/2017] [Indexed: 01/31/2023]
Abstract
Hydrocephalus (HCP) is a common complication in patients with subarachnoid hemorrhage. In this review, we summarize the advanced research on HCP and discuss the understanding of the molecular originators of HCP and the development of diagnoses and remedies of HCP after SAH. It has been reported that inflammation, apoptosis, autophagy, and oxidative stress are the important causes of HCP, and well-known molecules including transforming growth factor, matrix metalloproteinases, and iron terminally lead to fibrosis and blockage of HCP. Potential medicines for HCP are still in preclinical status, and surgery is the most prevalent and efficient therapy, despite respective risks of different surgical methods, including lamina terminalis fenestration, ventricle-peritoneal shunting, and lumbar-peritoneal shunting. HCP remains an ailment that cannot be ignored and even with various solutions the medical community is still trying to understand and settle why and how it develops and accordingly improve the prognosis of these patients with HCP.
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Siasios I, Kapsalaki EZ, Fountas KN, Fotiadou A, Dorsch A, Vakharia K, Pollina J, Dimopoulos V. The role of diffusion tensor imaging and fractional anisotropy in the evaluation of patients with idiopathic normal pressure hydrocephalus: a literature review. Neurosurg Focus 2017; 41:E12. [PMID: 27581308 DOI: 10.3171/2016.6.focus16192] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) for the assessment of fractional anisotropy (FA) and involving measurements of mean diffusivity (MD) and apparent diffusion coefficient (ADC) represents a novel, MRI-based, noninvasive technique that may delineate microstructural changes in cerebral white matter (WM). For example, DTI may be used for the diagnosis and differentiation of idiopathic normal pressure hydrocephalus (iNPH) from other neurodegenerative diseases with similar imaging findings and clinical symptoms and signs. The goal of the current study was to identify and analyze recently published series on the use of DTI as a diagnostic tool. Moreover, the authors also explored the utility of DTI in identifying patients with iNPH who could be managed by surgical intervention. METHODS The authors performed a literature search of the PubMed database by using any possible combinations of the following terms: "Alzheimer's disease," "brain," "cerebrospinal fluid," "CSF," "diffusion tensor imaging," "DTI," "hydrocephalus," "idiopathic," "magnetic resonance imaging," "normal pressure," "Parkinson's disease," and "shunting." Moreover, all reference lists from the retrieved articles were reviewed to identify any additional pertinent articles. RESULTS The literature search retrieved 19 studies in which DTI was used for the identification and differentiation of iNPH from other neurodegenerative diseases. The DTI protocols involved different approaches, such as region of interest (ROI) methods, tract-based spatial statistics, voxel-based analysis, and delta-ADC analysis. The most studied anatomical regions were the periventricular WM areas, such as the internal capsule (IC), the corticospinal tract (CST), and the corpus callosum (CC). Patients with iNPH had significantly higher MD in the periventricular WM areas of the CST and the CC than had healthy controls. In addition, FA and ADCs were significantly higher in the CST of iNPH patients than in any other patients with other neurodegenerative diseases. Gait abnormalities of iNPH patients were statistically significantly and negatively correlated with FA in the CST and the minor forceps. Fractional anisotropy had a sensitivity of 94% and a specificity of 80% for diagnosing iNPH. Furthermore, FA and MD values in the CST, the IC, the anterior thalamic region, the fornix, and the hippocampus regions could help differentiate iNPH from Alzheimer or Parkinson disease. Interestingly, CSF drainage or ventriculoperitoneal shunting significantly modified FA and ADCs in iNPH patients whose condition clinically responded to these maneuvers. CONCLUSIONS Measurements of FA and MD significantly contribute to the detection of axonal loss and gliosis in the periventricular WM areas in patients with iNPH. Diffusion tensor imaging may also represent a valuable noninvasive method for differentiating iNPH from other neurodegenerative diseases. Moreover, DTI can detect dynamic changes in the WM tracts after lumbar drainage or shunting procedures and could help identify iNPH patients who may benefit from surgical intervention.
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Affiliation(s)
- Ioannis Siasios
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| | | | | | | | - Alexander Dorsch
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| | - Kunal Vakharia
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
| | - Vassilios Dimopoulos
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York;,Department of Neurosurgery, Kaleida Health, Buffalo, New York; and
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Hori M, Kamiya K, Irie R. Advanced diffusion-weighted magnetic resonance imaging in the evaluation of white matter axons in patients with idiopathic normal pressure hydrocephalus. Neural Regen Res 2017; 12:1974-1975. [PMID: 29323031 PMCID: PMC5784340 DOI: 10.4103/1673-5374.221149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Irie R, Tsuruta K, Hori M, Suzuki M, Kamagata K, Nakanishi A, Kamiya K, Nakajima M, Miyajima M, Arai H, Aoki S. Neurite orientation dispersion and density imaging for evaluation of corticospinal tract in idiopathic normal pressure hydrocephalus. Jpn J Radiol 2016; 35:25-30. [PMID: 27787666 DOI: 10.1007/s11604-016-0594-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/20/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate diffusional changes of the corticospinal tract (CST) in patients with idiopathic normal pressure hydrocephalus (iNPH) by neurite orientation dispersion and density imaging (NODDI). MATERIALS AND METHODS Nineteen patients with iNPH and 12 healthy controls were included. Diffusion MRI data for NODDI were acquired with a 3-T system, using 32 motion-probing gradient directions with six b-values (from 0 to 2500 s/mm2). The orientation dispersion index (ODI), intra-cellular volume fraction (Vic), and isotropic volume fraction (Viso) of the CST were calculated by tract-specific analysis in patients and controls. We also measured the fractional anisotropy (FA) and apparent diffusion coefficient (ADC). RESULTS The ODI of the CST (0.087 ± 0.024 vs. 0.183 ± 0.051, P < 0.01, Mann-Whitney U test) and Vic of the CST (0.551 ± 0.061 vs. 0.628 ± 0.038, P < 0.01, Mann-Whitney U test) were significantly lower in iNPH patients than in healthy controls. In receiver-operating characteristic analysis, the area under the curve (AUC) of the ODI and FA were not significantly different (Fig. 4a, 0.987 vs. 0.904, P = 0.061), and the AUC of the Vic and ADC also showed no significant difference (Fig. 4b, 0.864 vs. 0.912, P = 0.194). CONCLUSION The NODDI can effectively evaluate the condition of neurites in the CST of iNPH patients, and the ODI could be clinically useful in the diagnosis of iNPH.
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Affiliation(s)
- Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kohei Tsuruta
- Department of Radiological Sciences, Tokyo Metropolitan University Graduate School of Human Health Sciences, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsushi Nakanishi
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kouhei Kamiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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New RESOLVE-Based Diffusional Kurtosis Imaging in MRI-Visible Prostate Cancer: Effect of Reduced b Value on Image Quality and Diagnostic Effectiveness. AJR Am J Roentgenol 2016; 207:330-8. [PMID: 27187062 DOI: 10.2214/ajr.15.15990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this article was to investigate whether a new readout segmentation of long variable echo-trains (RESOLVE)-based diffusional kurtosis imaging (DKI) with reduced b value technique can affect image quality and diagnostic effectiveness in MRI-visible prostate cancer (PCA). SUBJECTS AND METHODS Prostatic RESOLVE DKI (0-1400 s/mm2) was prospectively performed for 12 volunteers. The optimal protocol was then performed in 108 MRI-visible PCAs to determine whether it can compete against a preferred b-value set (0-2000 s/mm(2)) regarding image quality and diagnostic effectiveness. Images were interpreted by two independent radiologists using the prostate imaging reporting and data system (PI-RADS). Readers' concordance and diagnostic effectiveness were tested with the Fleiss kappa and area under the ROC curve (Az) analyses. RESULTS A b value of 1400 s/mm(2) generated a larger apparent diffusion coefficient of gaussian distribution (Dapp) (1.35 ± 0.31 vs 1.30 ± 0.30 mm(2)/s; p < 0.001) and apparent kurtosis coefficient (Kapp) (1.11 ± 0.26 vs 1.00 ± 0.21; p < 0.001) in PCA than did a b value of 2000 s/mm(2). Interreader agreement using PI-RADS was relatively low when Dapp and Kapp maps were excluded from image interpretations (κ = 0.39-0.41 vs κ = 0.66-0.68 with Dapp and Kapp maps). Interreader agreement in staging PCA was relatively high (κ > 0.80) and was not influenced by reducing the b value. The power of Dapp and Kapp to differentiate PCA from normal tissue (Az = 0.97-0.98), tissue with a Gleason score less than or equal to 3 + 4 from tissue with a Gleason score greater than 3 + 4 (Az = 0.77-0.82), and PCA stage lower than pT3 from stage pT3 and higher PCA (Az = 0.70-0.75) was not significantly degraded by reducing the b value. CONCLUSION We found that b values significantly influenced image quality, PI-RADS score, and DKI outputs but did not degrade the diagnostic effectiveness of DKI parameters to detect and classify PCA.
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Kamiya K, Kamagata K, Miyajima M, Nakajima M, Hori M, Tsuruta K, Mori H, Kunimatsu A, Arai H, Aoki S, Ohtomo K. Diffusional Kurtosis Imaging in Idiopathic Normal Pressure Hydrocephalus: Correlation with Severity of Cognitive Impairment. Magn Reson Med Sci 2016; 15:316-23. [PMID: 26841854 PMCID: PMC5608128 DOI: 10.2463/mrms.mp.2015-0093] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Diffusional kurtosis imaging (DKI) is an emerging technique that describes diffusion of water molecules in terms of deviation from Gaussian distribution. This study investigated correlations between DKI metrics and cognitive function in patients with idiopathic normal pressure hydrocephalus (iNPH). MATERIALS AND METHODS DKI was performed in 29 iNPH patients and 14 age-matched controls. Mini-mental state examination (MMSE), frontal assessment battery (FAB), and trail making test A (TMT-A) were used as cognitive measures. Tract-based spatial statistics (TBSS) analyses were performed to investigate the between-group differences and correlations with the cognitive measures of the diffusion metrics, including mean kurtosis (MK), fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD). RESULTS In iNPH patients, FA and MK identified positive correlations with cognitive function in similar regions, predominantly in the frontal lobes (P < 0.05, corrected for multiple comparisons). The frontoparietal subcortical white matter showed significant correlations with FAB and TMT-A across more extensive areas in MK analyses than in FA. ADC, AD, and RD analyses showed no significant correlations with MMSE and FAB, while negative correlation with TMT-A was observed in the limited portion of the frontal deep white matter. CONCLUSION Both FA and MK correlated well with cognitive impairment in iNPH. The observed differences between FA and MK results suggest DKI may play a complementary role to conventional FA and ADC analyses, especially for evaluation of the subcortical white matter.
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Affiliation(s)
- Kouhei Kamiya
- Department of Radiology, Graduate School of Medicine, University of Tokyo
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Time Course of Diffusion Kurtosis in Cerebral Infarctions of Transient Middle Cerebral Artery Occlusion Rat Model. J Stroke Cerebrovasc Dis 2015; 25:610-7. [PMID: 26725123 DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/10/2015] [Accepted: 11/22/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between fiber bundle direction and changes in diffusion kurtosis, we evaluated the apparent diffusion kurtosis coefficients (AKCs) that were perpendicular to and parallel to the principal diffusion tensor eigenvector. MATERIALS AND METHODS Adult male Wistar rats were subjected to 30 or 60 minutes of middle cerebral artery occlusion and imaged with a 7T Magnetic Resonance Imager System (Varian MRI System 7T/210: Agilent Technologies, CA). Diffusion kurtosis images were obtained before middle cerebral artery (MCA) reperfusion and 3, 6, and 24 hours after reperfusion to generate the apparent diffusion coefficient (ADC), fractional anisotropy (FA), mean apparent diffusion kurtosis coefficient (mAKC), AKC axial to the eigenvector (axAKC), and AKC radial to the eigenvector (radAKC) images. The time course of the region/normal ratio was evaluated for the above parameters in the caudoputamen and white matter. RESULTS Relative FA and relative ADC values decreased 3 hours after MCA reperfusion and remained decreased until 24 hours. Relative mAKC, axAKC, and radAKC values were increased 3 hours after MCA reperfusion, peaked after 6 hours, and slightly decreased after 24 hours. In the white matter, axAKC showed larger changes than radAKC. CONCLUSION The time course of the diffusion kurtosis value showed earlier pseudonormalization than the ADC value of the lesions. For white matter lesions, the increase in axAKC was larger than that in radAKC, suggesting that the tissue changes after infarction mainly produce reduced diffusivity along the fibers and lead to increased inhomogeneity of the diffusion.
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Hori M, Kamiya K, Nakanishi A, Fukunaga I, Miyajima M, Nakajima M, Suzuki M, Suzuki Y, Irie R, Kamagata K, Arai H, Aoki S. Prospective estimation of mean axon diameter and extra-axonal space of the posterior limb of the internal capsule in patients with idiopathic normal pressure hydrocephalus before and after a lumboperitoneal shunt by using q-space diffusion MRI. Eur Radiol 2015; 26:2992-8. [PMID: 26694062 PMCID: PMC4972860 DOI: 10.1007/s00330-015-4162-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/20/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
Objectives To prospectively estimate the mean axon diameter (MAD) and extracellular space of the posterior limb of the internal capsule (PLIC) in patients with idiopathic normal pressure hydrocephalus (iNPH) before and after a lumboperitoneal (LP) shunting operation using q-space diffusion MRI analysis. Methods We studied 12 consecutive patients with iNPH and 12 controls at our institution. After conventional magnetic resonance imaging (MRI), q-space image (QSI) data were acquired with a 3-T MRI scanner. The MAD and extra-axonal space of the PLIC before and after LP shunting were calculated using two-component q-space imaging analyses; the before and after values were compared. Results After LP shunt surgery, the extracellular space of the PLIC was significantly higher than that of the same patients before the operation (one-way analysis of variance (ANOVA) with Scheffé’s post-hoc test, P = 0.024). No significant differences were observed in the PLIC axon diameters among normal controls or in patients before and after surgery. Conclusion Increases in the root mean square displacement in the extra-axonal space of the PLIC in patients with iNPH after an LP shunt procedure are associated with the microstructural changes of white matter and subsequent abatement of patient symptoms. Key Points • Q-space diffusion MRI provides information on microstructural changes in the corticospinal tract • Lumboperitoneal (LP) shunting operation is useful for idiopathic normal pressure hydrocephalus • Q-space measurement may be a biomarker for the effect of the LP shunt procedure
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Affiliation(s)
- Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kouhei Kamiya
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Atsushi Nakanishi
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Issei Fukunaga
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Health Science, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuriko Suzuki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, 2333 ZA, Netherlands
| | - Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Cagnin A, Simioni M, Tagliapietra M, Citton V, Pompanin S, Della Puppa A, Ermani M, Manara R. A Simplified Callosal Angle Measure Best Differentiates Idiopathic-Normal Pressure Hydrocephalus from Neurodegenerative Dementia. J Alzheimers Dis 2015; 46:1033-8. [DOI: 10.3233/jad-150107] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Annachiara Cagnin
- Department of Neurosciences, University of Padova, Padova, Italy
- IRCCS San Camillo Hospital Foundation, Venice, Italy
| | | | | | | | - Sara Pompanin
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Mario Ermani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Renzo Manara
- Neuroradiology, Section of Neurosciences, University of Salerno, Salerno, Italy
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29
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Miyajima M, Kazui H, Mori E, Ishikawa M. One-year outcome in patients with idiopathic normal-pressure hydrocephalus treated with a lumbo-peritoneal shunt (SINPHONI-2), compared to ventriculo-peritoneal shunt (SINPHONI) used as a historical control. Fluids Barriers CNS 2015. [PMCID: PMC4582353 DOI: 10.1186/2045-8118-12-s1-o46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Kamiya K, Hori M, Miyajima M, Nakajima M, Suzuki Y, Kamagata K, Suzuki M, Arai H, Ohtomo K, Aoki S. Axon diameter and intra-axonal volume fraction of the corticospinal tract in idiopathic normal pressure hydrocephalus measured by q-space imaging. PLoS One 2014; 9:e103842. [PMID: 25093733 PMCID: PMC4122461 DOI: 10.1371/journal.pone.0103842] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 07/02/2014] [Indexed: 11/26/2022] Open
Abstract
Purpose Previous studies suggest that compression and stretching of the corticospinal tract (CST) potentially cause treatable gait disturbance in patients with idiopathic normal pressure hydrocephalus (iNPH). Measurement of axon diameter with diffusion MRI has recently been used to investigate microstructural alterations in neurological diseases. In this study, we investigated alterations in the axon diameter and intra-axonal fraction of the CST in iNPH by q-space imaging (QSI) analysis. Methods Nineteen patients with iNPH and 10 age-matched controls were recruited. QSI data were obtained with a 3-T system by using a single-shot echo planar imaging sequence with the diffusion gradient applied parallel to the antero-posterior axis. By using a two-component low-q fit model, the root mean square displacements of intra-axonal space ( = axon diameter) and intra-axonal volume fraction of the CST were calculated at the levels of the internal capsule and body of the lateral ventricle, respectively. Results Wilcoxon's rank-sum test revealed a significant increase in CST intra-axonal volume fraction at the paraventricular level in patients (p<0.001), whereas no significant difference was observed in the axon diameter. At the level of the internal capsule, neither axon diameter nor intra-axonal volume fraction differed significantly between the two groups. Conclusion Our results suggest that in patients with iNPH, the CST does not undergo irreversible axonal damage but is rather compressed and/or stretched owing to pressure from the enlarged ventricle. These analyses of axon diameter and intra-axonal fraction yield insights into microstructural alterations of the CST in iNPH.
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Affiliation(s)
- Kouhei Kamiya
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuriko Suzuki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Philips Electronics Japan, Ltd., Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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31
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Hori M, Tsutsumi S, Yasumoto Y, Ito M, Suzuki M, Tanaka FS, Kyogoku S, Nakamura M, Tabuchi T, Fukunaga I, Suzuki Y, Kamagata K, Masutani Y, Aoki S. Cervical spondylosis: Evaluation of microstructural changes in spinal cord white matter and gray matter by diffusional kurtosis imaging. Magn Reson Imaging 2014; 32:428-32. [PMID: 24602824 DOI: 10.1016/j.mri.2014.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 01/20/2014] [Accepted: 01/24/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We investigated microstructural changes in the spinal cord, separately for white matter and gray matter, in patients with cervical spondylosis by using diffusional kurtosis imaging (DKI). METHODS We studied 13 consecutive patients with cervical myelopathy (15 affected sides and 11 unaffected sides). After conventional magnetic resonance (MR) imaging, DKI data were acquired by using a 3T MR imaging scanner. Values for fractional anisotropy (FA), apparent diffusion coefficient (ADC), and mean diffusional kurtosis (MK) were calculated and compared between unaffected and affected spinal cords, separately for white matter and gray matter. RESULTS Tract-specific analysis of white matter in the lateral funiculus showed no statistical differences between the affected and unaffected sides. In gray matter, only MK was significantly lower in the affected spinal cords than in unaffected spinal cords (0.60±0.18 vs. 0.73±0.13, P=0.0005, Wilcoxon's signed rank test). CONCLUSIONS MK values in the spinal cord may reflect microstructural changes and gray matter damage and can potentially provide more information beyond that obtained with conventional diffusion metrics.
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Affiliation(s)
- Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Masanori Ito
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Fumine S Tanaka
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinsuke Kyogoku
- Department of Radiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | | | - Issei Fukunaga
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan; Department of Health Science, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuriko Suzuki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan; Philips Electronics Japan, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
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Giannelli M, Diciotti S, Guerrisi M, Traino AC, Mascalchi M, Tessa C, Toschi N. On the estimation of conventional DTI-derived indices by fitting the non-Gaussian DKI model to diffusion-weighted imaging datasets. Neuroradiology 2013; 55:1423-4. [PMID: 24005831 DOI: 10.1007/s00234-013-1271-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
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