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Deng Z, Wang H, Yang X, Huang K, Li Y, Hu N, Zhou L. Evaluation of imaging indicators in differentiating idiopathic normal pressure hydrocephalus from Alzheimer's disease. Clin Neurol Neurosurg 2024; 242:108362. [PMID: 38823198 DOI: 10.1016/j.clineuro.2024.108362] [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: 04/29/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND There are currently many imaging indicators for idiopathic normal pressure hydrocephalus (iNPH). However, their diagnostic performance has not been well compared, especially in differentiating iNPH from Alzheimer's disease (AD). This study aimed to evaluate the diagnostic performance of these imaging indicators in differentiating iNPH from AD. METHODS We retrospectively collected patients with iNPH from the West China Hospital between June 2016 and December 2023. Age-sex-matched patients with AD and healthy controls (HCs) are included as controls (ChiCTR2300070078, March 2023). Twelve imaging indicators were evaluated on MRI, including disproportionately enlarged subarachnoid space hydrocephalus (DESH), Evans' index (EI), callosal angle, z-EI, temporal horn, dilated Sylvian fissure, focal sulcal dilation, tight high convexity, deep white matter hyperintensities, periventricular hyperintensities, DESH scale, and Simplified Radscale. We analyzed the receiver operating characteristic curves and calculated the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy. RESULTS A total of 46 patients with iNPH (mean age: 73.1 ± 6.5; 35 males), 46 patients with AD (mean age: 73.0 ± 6.6; 35 males), and 46 HCs (mean age: 73.0 ± 5.9; 35 males) were included. The largest area under the receiver operating characteristic curve (AUC) was found in EI (0.93; 95 % CI: 0.89-0.98) and z-EI (0.93; 95 % CI: 0.87-0.98). DESH scale ≥ 6 had the highest specificity (93 %, 43/46). CONCLUSION EI and z-EI had the best diagnostic performance in differentiating iNPH from AD. The DESH scale could assist in diagnosing iNPH due to its high specificity.
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Affiliation(s)
- Ziang Deng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Haoxiang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiyue Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Keru Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyou Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Na Hu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China; Department of Neurosurgery, The Fifth people's Hospital of Ningxia, Shizuishan, China.
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2
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Komoda H, Morita D, Nakayama T, Iwase T. Idiopathic normal pressure hydrocephalus possibly affects the occurrence of proximal femoral fracture. Orthop Traumatol Surg Res 2023; 109:103545. [PMID: 36623705 DOI: 10.1016/j.otsr.2023.103545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023]
Abstract
AIMS The clinical triad of idiopathic normal pressure hydrocephalus (iNPH) includes gait disturbance, dementia, and urinary incontinence. These symptoms are also frequently observed in patients with proximal femoral fracture (PFF). The aim of this study was to investigate the relationship between PFF and iNPH retrospectively. PATIENTS AND METHODS Of the130 patients over 80-years-old with PFF included in this study, 48 were assigned to the PFF group. Forty-eight patients with peripheral vertigo matched with the PFF group for age and sex were included in the control group. We compared the Evans' index (EI), which is a head computed tomography finding of iNPH, and the percentages of patients with EI>0.3 between the two groups. The PFF group was further divided into two subgroups depending on whether EI was higher or lower than 0.3 (the higher or lower subgroup, respectively). We compared the patient's gait abilities before PFF, causes of PFF, cognitive functions, and occurrence of urinary incontinence between both groups. RESULTS The mean value of EI in the PFF group was significantly higher than that in the control group (PFF group, 0.301; control group, 0.284; p=0.008). The percentages of patients with EI>0.3 in the PFF and control groups were 62.5% and 35.4%, respectively (p=0.014). In subgroup analyses, the gait ability before injury was worse in the higher subgroup than that in the lower subgroup and was prominent among individuals who could walk only with human assistance (p=0.018). There were no significant differences in other parameters. CONCLUSION Elderly patients with PFF may have underlying idiopathic normal pressure hydrocephalus. LEVEL OF EVIDENCE III; case-control comparative study.
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Affiliation(s)
- Hidenori Komoda
- Department of Orthopedic surgery, Hamamatsu medical center, Shizuoka, Japan
| | - Daigo Morita
- Department of Orthopedic surgery, Hamamatsu medical center, Shizuoka, Japan.
| | - Teiji Nakayama
- Department of Neurosurgery, Hamamatsu medical center, Shizuoka, Japan
| | - Toshiki Iwase
- Department of Orthopedic surgery, Hamamatsu medical center, Shizuoka, Japan
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3
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Komura S, Nomura T, Imaizumi T, Inamura S, Kanno A, Honda O, Hashimoto Y, Nonaka T. Asymptomatic cerebral findings on 3-Tesla MRI in patients with severe carotid artery stenoses. J Clin Neurosci 2022; 101:106-111. [DOI: 10.1016/j.jocn.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/19/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
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4
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Jochems ACC, Muñoz Maniega S, Del C Valdés Hernández M, Barclay G, Anblagan D, Ballerini L, Meijboom R, Wiseman S, Taylor AM, Corley J, Chappell FM, Backhouse EV, Stringer MS, Dickie DA, Bastin ME, Deary IJ, Cox SR, Wardlaw JM. Contribution of white matter hyperintensities to ventricular enlargement in older adults. Neuroimage Clin 2022; 34:103019. [PMID: 35490587 PMCID: PMC9062739 DOI: 10.1016/j.nicl.2022.103019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/24/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
Lateral ventricles might increase due to generalized tissue loss related to brain atrophy. Alternatively, they may expand into areas of tissue loss related to white matter hyperintensities (WMH). We assessed longitudinal associations between lateral ventricle and WMH volumes, accounting for total brain volume, blood pressure, history of stroke, cardiovascular disease, diabetes and smoking at ages 73, 76 and 79, in participants from the Lothian Birth Cohort 1936, including MRI data from all available time points. Lateral ventricle volume increased steadily with age, WMH volume change was more variable. WMH volume decreased in 20% and increased in remaining subjects. Over 6 years, lateral ventricle volume increased by 3% per year of age, 0.1% per mm Hg increase in blood pressure, 3.2% per 1% decrease of total brain volume, and 4.5% per 1% increase of WMH volume. Over time, lateral ventricle volumes were 19% smaller in women than men. Ventricular and WMH volume changes are modestly associated and independent of general brain atrophy, suggesting that their underlying processes do not fully overlap.
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Affiliation(s)
- Angela C C Jochems
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Susana Muñoz Maniega
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK
| | - Maria Del C Valdés Hernández
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK
| | - Gayle Barclay
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Devasuda Anblagan
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK
| | - Lucia Ballerini
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK
| | - Rozanna Meijboom
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK
| | - Stewart Wiseman
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK
| | - Adele M Taylor
- Lothian Birth Cohorts Group, The University of Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Janie Corley
- Lothian Birth Cohorts Group, The University of Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Francesca M Chappell
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ellen V Backhouse
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK
| | - Michael S Stringer
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - David Alexander Dickie
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Mark E Bastin
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK
| | - Ian J Deary
- Lothian Birth Cohorts Group, The University of Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Lothian Birth Cohorts Group, The University of Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK; Lothian Birth Cohorts Group, The University of Edinburgh, UK.
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5
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Illies T, Eckert B, Kehler U. What Radiologists Should Know About Normal Pressure Hydrocephalus. ROFO-FORTSCHR RONTG 2021; 193:1197-1206. [PMID: 34530457 DOI: 10.1055/a-1425-8065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Normal pressure hydrocephalus is a disease in elderly patients and one of the most common causes of treatable dementia. It occurs frequently with microangiopathy and Alzheimer's disease, so that differential diagnosis plays an important role. This is crucially determined by imaging findings. Therapy consists of cerebrospinal fluid drainage through a shunt, which should be performed as early as possible to improve the chances of success. METHOD This report is based on a summary of the relevant literature that has been reviewed in PubMed with reference to epidemiology, symptoms, pathophysiology, diagnostics, and therapy. The results were supplemented by the joint guidelines of the German Society of Neurology and the German Society of Neurosurgery. RESULTS AND CONCLUSION The understanding of the pathophysiologic changes leading to normal pressure hydrocephalus has expanded significantly in recent years to include concepts explaining relevant comorbidities. Diagnosis is based on radiological and clinical indicators, although accurate differentiation with respect to comorbidities is not always possible. A high response rate to treatment can be achieved by good patient selection. Positive prognostic markers for therapeutic success include Disproportionately Enlarged Subarachnoid Space Hydrocephalus (DESH), short disease duration, predominant gait disturbance, and few comorbidities. KEY POINTS · Normal pressure hydrocephalus mainly affects patients older than 65 years of age with high comorbidity rate for microangiopathy and Alzheimer's disease. · Radiologic findings play an important role in the diagnosis and follow-up after shunting. · The earlier a shunt is placed, the better the outcome. CITATION FORMAT · Illies T, Eckert B, Kehler U. What Radiologists Should Know About Normal Pressure Hydrocephalus. Fortschr Röntgenstr 2021; 193: 1197 - 1206.
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Affiliation(s)
- Till Illies
- Fachbereich Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany
| | - Bernd Eckert
- Fachbereich Neuroradiologie, Asklepios Klinik Altona, Hamburg, Germany
| | - Uwe Kehler
- Abt. f. Neurochirurgie, Asklepios Klinik Altona, Hamburg, Germany
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6
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Nishikawa T, Akiguchi I, Satoh M, Hara A, Hirano M, Hosokawa A, Metoki H, Asayama K, Kikuya M, Nomura K, Hozawa A, Miyamatsu N, Imai Y, Ohkubo T. The association of disproportionately enlarged subarachnoid space hydrocephalus with cognitive deficit in a general population: the Ohasama study. Sci Rep 2021; 11:17061. [PMID: 34426609 PMCID: PMC8382837 DOI: 10.1038/s41598-021-95961-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022] Open
Abstract
Disproportionately enlarged subarachnoid space hydrocephalus (DESH) is the characteristic feature of idiopathic normal pressure hydrocephalus. We aimed to characterize the prevalence, development, and association of DESH to cognitive deficit in a large population. We reviewed the data of 1384 subjects eligible for the present study among 1590 participants who underwent magnetic resonance imaging (MRI) in the Ohasama Study, a population-based study in Ohasama, Japan. The participants with Mini-Mental State Examination (MMSE) score < = 25 were assumed to have cognitive deficit and DESH was evaluated by reviewing the MRIs. We assessed the association between DESH, Evans index (EI), and cognitive deficit using multivariate logistic regression models adjusted for relevant confounders. Furthermore, we evaluated the new development of DESH and the deterioration of cognitive function in the participants with DESH. There were nine participants with DESH (0.65%), seven of whom showed cognitive deficit. DESH was significantly associated with cognitive deficit in multivariate regression analyses (odds ratio; 8.50 [95% confidence interval: 1.61–44.88]). In the 669 participants who underwent follow-up MRI, we found four participants newly presenting with DESH; the development of DESH was observed before/after the presence of EI > 0.3. We also found two participants with existing DESH showing no remarkable worsening in MMSE and EI. The present study demonstrated a positive association between the presence of DESH and cognitive deficit. DESH can develop independently of EI > 0.3, and ventricular enlargement in combination with DESH may be an important factor in the worsening of cognitive deficit.
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Affiliation(s)
- Tomofumi Nishikawa
- Faculty of Health Science, Kyoto Koka Women's University, 38 Kadonocho, Nishikyogoku, Ukyo-ku, Kyoto, 615-0822, Japan.
| | - Ichiro Akiguchi
- Center of Neurological and Cerebrovascular Diseases, Koseikai Takeda Hospital, Kyoto, Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Mikio Hirano
- Department of Human Science, Faculty of Liberal Arts, Tohoku Gakuin University, Sendai, Japan
| | - Aya Hosokawa
- Department of Occupational Therapy, Faculty of Health Sciences, Aino University, Osaka, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Kei Asayama
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Kikuya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Kyoko Nomura
- Department of Public Health, Akita University Graduate School of Medicine and Faculty of Medicine, Akita, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
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7
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Currà A, Pierelli F, Gasbarrone R, Mannarelli D, Nofroni I, Matone V, Marinelli L, Trompetto C, Fattapposta F, Missori P. The Ventricular System Enlarges Abnormally in the Seventies, Earlier in Men, and First in the Frontal Horn: A Study Based on More Than 3,000 Scans. Front Aging Neurosci 2019; 11:294. [PMID: 31749695 PMCID: PMC6848156 DOI: 10.3389/fnagi.2019.00294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/14/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives: To detect on computed tomography (CT) brain scans the trajectories of normal and abnormal ventricular enlargement during aging. Methods: For each 1-year age cohort, we assessed in 3,193 axial CT scans the Evans’ index (EI) in the anterior frontal horns and the parieto-occipital (POR) and temporal ratio (TR) in the posterior and inferior horns. Cut-off values for abnormal enlargement were based on previous clinical studies. Results: The mean age associated with normal linear measures was 71 years. Values for all three measures increased with age, showing a linear relationship below—but not above—each cut-off value. The mean age of participants with abnormal enlargement on CT progressed from 79 years for EI to 83 years for POR to 87 years for TR. These results suggested that ventricular dilatation progresses in an age–location relationship. First comes enlargement of the frontal horns (13.8% of scans), followed by the parieto-occipital horns (15.1% of scans) and then temporal horn enlargement (6.8% of scans). Scans from men displayed abnormal values earlier than scans from women (on average 6 years). Risk increased 5.1% annually for abnormal EI, 9.0% for abnormal POR, and 11% for abnormal TR (all p < 0.001). The most frequent agreement between categories (normal–abnormal) for values of neuroimaging measures was identified for POR–TR. Conclusion: The results of this large radiological study suggest that the ventricular system enlarges progressively during aging, and in a subset of patients follows an abnormal consecutive geometric dilatation, influenced by age and sex.
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Affiliation(s)
- Antonio Currà
- Academic Neurology Unit, A. Fiorini Hospital, Terracina, (LT), Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy
| | - Francesco Pierelli
- Academic Neuro-Rehabilitation Unit, ICOT, Latina, IRCCS Neuromed and Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy
| | - Riccardo Gasbarrone
- Department of Chemical Engineering, Materials & Environment, Sapienza University of Rome, Rome, Italy
| | - Daniela Mannarelli
- Neurology Unit, Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Italo Nofroni
- Department of Public Health and Infectious Diseases, Medical Statistics and Biometry, Sapienza University of Rome, Rome, Italy
| | - Vittoria Matone
- Neurosurgery Unit, Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Fattapposta
- Neurology Unit, Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Paolo Missori
- Neurosurgery Unit, Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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8
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Ménard B, Chazalviel L, Roussel S, Bernaudin M, Touzani O. Two-kidney one-clip is a pertinent approach to integrate arterial hypertension in animal models of stroke: Serial magnetic resonance imaging studies of brain lesions before and during cerebral ischemia. J Cereb Blood Flow Metab 2018; 38:1769-1780. [PMID: 28617154 PMCID: PMC6168912 DOI: 10.1177/0271678x17715813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Although chronic arterial hypertension (CAH) represents the major comorbid factor in stroke, it is rarely integrated in preclinical studies of stroke. The majority of those investigations employ spontaneously hypertensive rats (SHR) which display a susceptibility to ischemic damage independent of hypertension. Here, we used a renovascular model of hypertension (RH) to examine, with magnetic resonance imaging (MRI), brain alterations during the development of hypertension and after brain ischemia. We also examined whether MRI-derived parameters predict the extent of ischemia-induced brain damage. RH was induced according to the two-kidney one-clip model and multiparametric MRI was performed at 3, 6, 9, and 12 weeks after hypertension and also at 10, 50, and 60 min following stroke. Blood pressure values increased progressively and reached a plateau at 6 weeks after RH induction. At 12 weeks, all hypertensive animals displayed spontaneous brain lesions (hemorrhages, deep and cortical lesions, ventricular dilatation), increased apparent diffusion coefficient (ADC) values in the corpus callosum and higher fractional anisotropy in the cortex. Following ischemia, these animals showed larger brain lesions (406 ± 82 vs. 179 ± 36 mm3, p < 0.002) which correlated with ADC values at chronic stage of hypertension. This model of hypertension displays many characteristics of the neuropathology of human CAH. The use of this model in stroke studies is relevant and desirable.
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Affiliation(s)
- Benjamin Ménard
- Normandie Univ, UNICAEN, CNRS, CEA, ISTCT/CERVOxy group, Caen, France
| | | | - Simon Roussel
- Normandie Univ, UNICAEN, CNRS, CEA, ISTCT/CERVOxy group, Caen, France
| | - Myriam Bernaudin
- Normandie Univ, UNICAEN, CNRS, CEA, ISTCT/CERVOxy group, Caen, France
| | - Omar Touzani
- Normandie Univ, UNICAEN, CNRS, CEA, ISTCT/CERVOxy group, Caen, France
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9
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Missori P, Rughetti A, Peschillo S, Gualdi G, Di Biasi C, Nofroni I, Marinelli L, Fattapposta F, Currà A. In normal aging ventricular system never attains pathological values of Evans' index. Oncotarget 2017; 7:11860-3. [PMID: 26919252 PMCID: PMC4914253 DOI: 10.18632/oncotarget.7644] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022] Open
Abstract
Ventricular enlargement in normal aging frequently forces the radiological diagnosis of hydrocephalus, but the reliability of Evans' index as a radiological marker of abnormal ventricular enlargement (values > 0.30) during aging is not assessed. Here we analyze ventricular size during aging and the reliability of Evans' index as a radiological marker of abnormal ventricular enlargement. We calculated Evans' index in the axial Computed Tomography scans of 1221 consecutive individuals (aged 45-101 years) from an emergency department. Stratified analysis of one-year cohorts showed that the mean Evans' index value per class was invariably < 0.30. Roughly one out five Computed Tomography scans was associated with Evans' index values > 0.30 and Evans' index values increased with age. The risk of having an Evans' index value > 0.30 increased by 7.8% per year of age (p < 0.001) and males were at 83.9% greater risk than females (p < 0.001). Overall, this study shows that normal aging enlarges the ventricular system, but never causes abnormal ventricular enlargement. Evans' index values > 0.30 should reflect an underlying neurological condition in every individual.
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Affiliation(s)
- Paolo Missori
- Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Aurelia Rughetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Simone Peschillo
- Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, "Sapienza" University of Rome, Rome, Italy
| | - Gianfranco Gualdi
- Department of Radiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Claudio Di Biasi
- Department of Radiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Italo Nofroni
- Department of Public Health and Infectious Diseases, Medical Statistics and Biometry, "Sapienza" University of Rome, Rome, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Francesco Fattapposta
- Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Neurology, A. Fiorini Hospital, Terracina, LT, "Sapienza" University of Rome, Polo Pontino, Italy
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10
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Jaraj D, Rabiei K, Marlow T, Jensen C, Skoog I, Wikkelsø C. Estimated ventricle size using Evans index: reference values from a population-based sample. Eur J Neurol 2017; 24:468-474. [DOI: 10.1111/ene.13226] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- D. Jaraj
- Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
- Neuropsychiatric Epidemiology Research Unit; Gothenburg Sweden
- Hydrocephalus Research Unit; Gothenburg Sweden
| | - K. Rabiei
- Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
- Hydrocephalus Research Unit; Gothenburg Sweden
| | - T. Marlow
- Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
- Neuropsychiatric Epidemiology Research Unit; Gothenburg Sweden
| | - C. Jensen
- Institute of Clinical Sciences; University of Gothenburg; Gothenburg Sweden
| | - I. Skoog
- Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
- Neuropsychiatric Epidemiology Research Unit; Gothenburg Sweden
| | - C. Wikkelsø
- Institute of Neuroscience and Physiology; University of Gothenburg; Gothenburg Sweden
- Hydrocephalus Research Unit; Gothenburg Sweden
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Age differences in periventricular and deep white matter lesions. Neurobiol Aging 2015; 36:1653-1658. [PMID: 25659858 DOI: 10.1016/j.neurobiolaging.2015.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 12/04/2014] [Accepted: 01/03/2015] [Indexed: 11/23/2022]
Abstract
Deep white matter hyperintensity (DWMH) and periventricular (PV) white matter lesion volumes are associated with age and subsequent stroke. We studied age differences in these volumes accounting for collinearity and risk factors. Subjects were 563 healthy family members of early-onset coronary artery disease patients. Using 3T magnetic resonance imaging, lesions were classified as DWMH or PV. Age association with lesion classification was analyzed using random effects Tobit regression, adjusting for intracranial volume (ICV) and risk factors. Subjects were 60% women, 36% African-American, mean age 51 ± 11 years. In multivariable analysis adjusted for PV and ICV, DWMH was associated with age (p < 0.001) and female sex (p = 0.003). PV, adjusted for DWMH and ICV, was age associated (p < 0.001). For each age decade, DWMH showed 0.07 log units/decade greater volume (95% CI = 0.04-0.11); PV was 0.18 log units/decade greater (95% CI = 0.14-0.23); slope differences (p < 0.001). In people with a family history of coronary artery disease, PV and DWMH are independently and differentially associated with age controlling for traditional risk factors.
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Ambarki K, Israelsson H, Wåhlin A, Birgander R, Eklund A, Malm J. Brain ventricular size in healthy elderly: comparison between Evans index and volume measurement. Neurosurgery 2013; 67:94-9; discussion 99. [PMID: 20559096 DOI: 10.1227/01.neu.0000370939.30003.d1] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A precise definition of ventricular enlargement is important in the diagnosis of hydrocephalus as well as in assessing central atrophy. The Evans index (EI), a linear ratio between the maximal frontal horn width and the cranium diameter, has been extensively used as an indirect marker of ventricular volume (VV). With modern imaging techniques, brain volume can be directly measured. OBJECTIVE To determine reference values of intracranial volumes in healthy elderly individuals and to correlate volumes with the EI. METHODS Magnetic resonance imaging (3 T) was performed in 46 healthy white elderly subjects (mean age+/-standard deviation, 71+/-6 years) and in 20 patients (74+/-7 years) with large ventricles according to visual inspection. VV, relative VV (RVV), and EI were assessed. Ventricular dilation was defined using VV and EI by a value above the 95th percentile range for healthy elderly individuals. RESULTS In healthy elderly subjects, we found VV=37+/-18 mL, RVV=2.47+/-1.17%, and EI=0.281+/-0.027. Including the patients, there was a strong correlation between EI and VV (R=0.94) as well as between EI and RVV (R=0.95). However, because of a wide 95% prediction interval (VV: +/-45 mL; RVV: +/-2.54%), EI did not give a sufficiently good estimate of VV and RVV. CONCLUSION VV (or RVV) and the EI reflect different properties. The exclusive use of EI in clinical studies as a marker of enlarged ventricles should be questioned. We suggest that the definition of dilated ventricles in white elderly individuals be defined as VV>77 mL or RVV>4.96 %. Future studies should compare intracranial volumes with clinical characteristics and prognosis.
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Affiliation(s)
- Khalid Ambarki
- Department of Biomedical Engineering, Umeå University, Umeå, Sweden.
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