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Cai H, Zou Y, Gao H, Huang K, Liu Y, Cheng Y, Liu Y, Zhou L, Zhou D, Chen Q. Radiological biomarkers of idiopathic normal pressure hydrocephalus: new approaches for detecting concomitant Alzheimer's disease and predicting prognosis. PSYCHORADIOLOGY 2022; 2:156-170. [PMID: 38665278 PMCID: PMC10917212 DOI: 10.1093/psyrad/kkac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 04/28/2024]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a clinical syndrome characterized by cognitive decline, gait disturbance, and urinary incontinence. As iNPH often occurs in elderly individuals prone to many types of comorbidity, a differential diagnosis with other neurodegenerative diseases is crucial, especially Alzheimer's disease (AD). A growing body of published work provides evidence of radiological methods, including multimodal magnetic resonance imaging and positron emission tomography, which may help noninvasively differentiate iNPH from AD or reveal concurrent AD pathology in vivo. Imaging methods detecting morphological changes, white matter microstructural changes, cerebrospinal fluid circulation, and molecular imaging have been widely applied in iNPH patients. Here, we review radiological biomarkers using different methods in evaluating iNPH pathophysiology and differentiating or detecting concomitant AD, to noninvasively predict the possible outcome postshunt and select candidates for shunt surgery.
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Affiliation(s)
- Hanlin Cai
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yinxi Zou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Hui Gao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Keru Huang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yu Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuting Cheng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yi Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Qin Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
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Mangano FT, Altaye M, Stevenson CB, Yuan W. The Construction of a Predictive Composite Index for Decision-Making of CSF Diversion Surgery in Pediatric Patients following Prenatal Myelomeningocele Repair. AJNR Am J Neuroradiol 2022; 43:1214-1221. [PMID: 35902125 PMCID: PMC9575433 DOI: 10.3174/ajnr.a7585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is a wide range of clinical and radiographic factors affecting individual surgeons' ultimate decision for CSF diversion for pediatric patients following prenatal myelomeningocele repair. Our aim was to construct a composite index (CSF diversion surgery index) that integrates conventional clinical measures and neuroimaging biomarkers to predict CSF diversion surgery in these pediatric patients. MATERIALS AND METHODS This was a secondary retrospective analysis of data from 33 patients with prenatal myelomeningocele repair (including 14 who ultimately required CSF diversion surgery). Potential independent variables, including the Management of Myelomeningocele Study Index (a dichotomized variable based on the shunt-placement criteria from the Management of Myelomeningocele Study), postnatal DTI measures (fractional anisotropy and mean diffusivity in the genu of the corpus callosum and the posterior limb of internal capsule), fronto-occipital horn ratio at the time of DTI, gestational ages, and sex, were evaluated using stepwise logistic regression analysis to identify the most important predictors. RESULTS The CSF diversion surgery index model showed that the Management of Myelomeningocele Study Index and fractional anisotropy in the genu of the corpus callosum were significant predictors (P < .05) of CSF diversion surgery. The predictive value of the CSF diversion surgery index was also affected by fractional anisotropy in the posterior limb of the internal capsule and sex with marginal effect (.05<P < .10), but not by the fronto-occipital horn ratio (P > .10). The overall CSF diversion surgery index model fit the data well with statistical significance (eg, likelihood ratio: P < .001), with the performance (sensitivity = 78.6%; specificity = 86.5%, overall accuracy = 84.8%) superior to all individual indices in sensitivity and overall accuracy, and most of the individual indices in specificity. CONCLUSIONS The CSF diversion surgery index model outperformed all single predictor models and, with additional validation, may potentially be developed and incorporated into a sensitive and robust clinical tool to assist clinicians in hydrocephalus management.
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Affiliation(s)
- F T Mangano
- From the Division of Pediatric Neurosurgery (F.T.M., C.B.S.).,University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio
| | - M Altaye
- Division of Biostatistics and Epidemiology (M.A.).,University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio
| | - C B Stevenson
- From the Division of Pediatric Neurosurgery (F.T.M., C.B.S.).,University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio
| | - W Yuan
- Pediatric Neuroimaging Research Consortium (W.Y.), Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio .,University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio
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Role of Diffusion Tensor Imaging in Diagnosis and Estimation of Shunt Effect for Hydrocephalus in Stroke Patients: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12061314. [PMID: 35741124 PMCID: PMC9221896 DOI: 10.3390/diagnostics12061314] [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] [Received: 04/05/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 12/10/2022] Open
Abstract
Hydrocephalus is a dilatation of the brain ventricular system by the accumulation of cerebrospinal fluid within the ventricle caused by impaired cerebrospinal fluid circulation or clearance. A diagnosis of hydrocephalus at the chronic stage of stroke has been mainly made by clinical features and radiologic findings on brain computed tomography and magnetic resonance imaging. On the other hand, it could not determine the effect of hydrocephalus or shunt effect on the periventricular neural structures. By contrast, these effects on the periventricular neural structures can be estimated using diffusion tensor imaging (DTI). This article reviewed 10 DTI-based studies related to the diagnosis and estimation of the shunt effect for hydrocephalus in stroke patients. These studies suggest that DTI could be a useful diagnostic and estimation tool of the shunt effect for hydrocephalus in stroke patients. In particular, some studies suggested that fractional anisotropy value in the periventricular white matter could be a diagnostic biomarker for hydrocephalus. As a result, the role of DTI in diagnosing and estimating the shunt effect for hydrocephalus in stroke patients appears to be promising. However, the number of studies and patients of all reviewed studies were limited (10 studies including a total of 58 stroke patients with heterogenous brain pathologies).
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Jang SH, Chang CH, Jung YJ, Seo YS. Restoration of the corticoreticular pathway following shunt operation for hydrocephalus in a stroke patient. Medicine (Baltimore) 2018; 97:e9512. [PMID: 29369173 PMCID: PMC5794357 DOI: 10.1097/md.0000000000009512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE We report on a stroke patient who showed restoration of discontinued corticoreticular pathways (CRPs) on serial diffusion tensor tractography (DTT) concurrent with recovery of gait disturbance following shunt operation for hydrocephalus. PATIENT CONCERNS A 67-year-old female patient underwent stereotactic drainage for management of intraventricular hemorrhage due to a rupture of the left posterior communicating artery. DIAGNOSES After 4 weeks from onset, the patient exhibited quadriparesis with more severe weakness in the proximal muscles and could not even stand or walk. She underwent comprehensive rehabilitation for 3 weeks. Her quadriparesis, as a result of hydrocephalus, did not improve significantly. INTERVENTIONS On the pre-op DTT, discontinuations (the right CRP: at subcortical white matter level, and the left CRP: at the midbrain level) of the CRP fibers from the premotor cortex were observed in both hemispheres. OUTCOMES She underwent a ventriculo-peritoneal shunt operation and her quadriparesis improved, especially the proximal muscles. Consequently, she could walk with mild assistance on an even floor at 5 days and walk on stairs at 4 weeks after the shunt operation. On the post-op DTT, the discontinued CRP fibers were elongated to the premotor cortex in both hemispheres. LESSONS Restoration of discontinued CRPs concurrent with recovery of gait disturbance following shunt operation for hydrocephalus was demonstrated in a stroke patient.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Young Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - You Sung Seo
- Department of Physical Medicine and Rehabilitation
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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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Zhao C, Li Y, Cao W, Xiang K, Zhang H, Yang J, Gan Y. Diffusion tensor imaging detects early brain microstructure changes before and after ventriculoperitoneal shunt in children with high intracranial pressure hydrocephalus. Medicine (Baltimore) 2016; 95:e5063. [PMID: 27759635 PMCID: PMC5079319 DOI: 10.1097/md.0000000000005063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To explore the use of diffusion tensor imaging (DTI) parameters in the quantitative assessment of early brain microstructure changes before and after ventriculoperitoneal shunt in children with high intracranial pressure hydrocephalus.Ten patients with communicating hydrocephalus (age: 2-36 months) and 14 age-/gender-matched controls (age: 2-36 months) were enrolled in this study. All patients underwent the ventriculoperitoneal shunt procedure. The imaging data were collected before and 3 months after the operation. Regions of interests (ROIs) included the white matter near the frontal horn of the lateral ventricles (FHLV), the occipital horn of the lateral ventricles (OHLV), occipital subcortical (OS) area, frontal subcortical (FS) area, and thalamus. Fractional anisotropies (FA) and apparent diffusion coefficients (ADC) of the ROIs before and after ventriculoperitoneal shunt were compared between the patients and the controls.Three months after surgery, the patients recovered from the surgery with ameliorated intracranial pressure and slight improvement of clinical intelligence scale and motor scale. Before ventriculoperitoneal shunt, the FA values (except the right FHLV) were significantly decreased and the ADC values were significantly increased in the patients with hydrocephalus, compared with the controls. After the ventriculoperitoneal shunt, the FA values in the FHLV and OHLV of the patients were similar to the controls, but the FA values in other ROIs were still significantly lower than controls. The ADC values in the FS and OS white matter areas of the patients were similar to the controls; however, the ADC values in other ROIs were still significantly higher in patients.The increase of FA and the reduction in ADC in the ROIs preceded the clinical function improvement in patients with high intracranial pressure hydrocephalus and reflected the early changes in brain tissue microstructure, such as the compression of the white matter areas in the ROIs.
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Affiliation(s)
- Cailei Zhao
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an
| | - Yongxin Li
- Institute of Clinical Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou
| | - Weiguo Cao
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen
| | - Kui Xiang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen
| | - Heye Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an
- Correspondence: Jian Yang, Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277, Yantaxi Road, Xi’an 710061, China (e-mail: ); Yungen Gan, Department of Radiology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Shenzhen 518038, China (e-mail: )
| | - Yungen Gan
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen
- Correspondence: Jian Yang, Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277, Yantaxi Road, Xi’an 710061, China (e-mail: ); Yungen Gan, Department of Radiology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Shenzhen 518038, China (e-mail: )
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Mangano FT, Altaye M, McKinstry RC, Shimony JS, Powell SK, Phillips JM, Barnard H, Limbrick DD, Holland SK, Jones BV, Dodd J, Simpson S, Deanna M, Rajagopal A, Bidwell S, Yuan W. Diffusion tensor imaging study of pediatric patients with congenital hydrocephalus: 1-year postsurgical outcomes. J Neurosurg Pediatr 2016; 18:306-19. [PMID: 27203134 PMCID: PMC5035704 DOI: 10.3171/2016.2.peds15628] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate white matter (WM) structural abnormalities using diffusion tensor imaging (DTI) in children with hydrocephalus before CSF diversionary surgery (including ventriculoperitoneal shunt insertion and endoscopic third ventriculostomy) and during the course of recovery after surgery in association with neuropsychological and behavioral outcome. METHODS This prospective study included 54 pediatric patients with congenital hydrocephalus (21 female, 33 male; age range 0.03-194.5 months) who underwent surgery and 64 normal controls (30 female, 34 male; age range 0.30-197.75 months). DTI and neurodevelopmental outcome data were collected once in the control group and 3 times (preoperatively and at 3 and 12 months postoperatively) in the patients with hydrocephalus. DTI measures, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values were extracted from the genu of the corpus callosum (gCC) and the posterior limb of internal capsule (PLIC). Group analysis was performed first cross-sectionally to quantify DTI abnormalities at 3 time points by comparing the data obtained in the hydrocephalus group for each of the 3 time points to data obtained in the controls. Longitudinal comparisons were conducted pairwise between different time points in patients whose data were acquired at multiple time points. Neurodevelopmental data were collected and analyzed using the Adaptive Behavior Assessment System, Second Edition, and the Bayley Scales of Infant Development, Third Edition. Correlation analyses were performed between DTI and behavioral measures. RESULTS Significant DTI abnormalities were found in the hydrocephalus patients in both the gCC (lower FA and higher MD, AD, and RD) and the PLIC (higher FA, lower AD and RD) before surgery. The DTI measures in the gCC remained mostly abnormal at 3 and 12 months after surgery. The DTI abnormalities in the PLIC were significant in FA and AD at 3 months after surgery but did not persist when tested at 12 months after surgery. Significant longitudinal DTI changes in the patients with hydrocephalus were found in the gCC when findings at 3 and 12 months after surgery were compared. In the PLIC, trend-level longitudinal changes were observed between preoperative findings and 3-month postoperative findings, as well as between 3- and 12-month postoperative findings. Significant correlation between DTI and developmental outcome was found at all 3 time points. Notably, a significant correlation was found between DTI in the PLIC at 3 months after surgery and developmental outcome at 12 months after surgery. CONCLUSIONS The data showed significant WM abnormality based on DTI in both the gCC and the PLIC in patients with congenital hydrocephalus before surgery, and the abnormalities persisted in both the gCC and the PLIC at 3 months after surgery. The DTI values remained significantly abnormal in the gCC at 12 months after surgery. Longitudinal analysis showed signs of recovery in both WM structures between different time points. Combined with the significant correlation found between DTI and neuropsychological measures, the findings of this study suggest that DTI can serve as a sensitive imaging biomarker for underlying neuroanatomical changes and postsurgical developmental outcome and even as a predictor for future outcomes.
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Affiliation(s)
- Francesco T. Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert C. McKinstry
- Mallinckrodt Institute of Radiology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Stephanie K. Powell
- Department of Neurology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO,Department of Psychology, St. Louis Children’s Hospital, St. Louis, MO
| | - Jannel M. Phillips
- Division of Developmental and Behavioral Pediatrics – Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Holly Barnard
- Division of Developmental and Behavioral Pediatrics – Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David D. Limbrick
- Department of Neurological Surgery, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | - Scott K. Holland
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Blaise V. Jones
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathon Dodd
- Department of Neurology, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO,Department of Psychology, St. Louis Children’s Hospital, St. Louis, MO
| | - Sarah Simpson
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Mercer Deanna
- Department of Neurological Surgery, Saint Louis, MO,Washington University School of Medicine, Saint Louis, MO
| | | | - Sarah Bidwell
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Weihong Yuan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati, Ohio
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Lee H, Jang SH. Change of cingulum following shunt operation for hydrocephalus in a patient with a haemorrhagic stroke. Clin Neurol Neurosurg 2016; 148:49-51. [PMID: 27391976 DOI: 10.1016/j.clineuro.2016.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/01/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Affiliation(s)
- HanDo Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea.
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Jang SH, Lee HD. Diffusion tensor tractography measurement of the distance between corticospinal tracts in patients with spontaneous intraventricular haemorrhage. J Int Med Res 2015; 44:164-9. [PMID: 26647075 PMCID: PMC5536564 DOI: 10.1177/0300060515597929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/30/2015] [Indexed: 11/25/2022] Open
Abstract
Objective The difference in the widest distance between corticospinal tracts (CST) on diffusion tensor tractography (DTT) in stroke patients with hydrocephalus was investigated retrospectively. Methods Distances were measured on an axial slice of the corona radiata, which provided the widest distance between CSTs. Two distances were measured, the absolute distance – the distance between the most medial point of the CSTs and the relative distance – calculated as a percentage of the absolute distance. Results The absolute distances of CSTs were 55.34 mm for the patient group and 46.75 mm for the control group. The relative distances of the CSTs were 44.12% and 35.96% for the patient group and the control group. Significant differences in the absolute and relative distances of CSTs were observed between the patient and the control group. Conclusion These results suggest that the absolute and relative distances between CSTs might be used to diagnose hydrocephalus in stroke patients.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Li Y, Zhao C, Tan Z, Wang Y, Zhang H, Wang J, Guo H, Zeng B, Huang W. Longitudinal Changes in the Brain Following Third Ventriculostomy in a Child With Hydrocephalus: A Case Report. Medicine (Baltimore) 2015; 94:e2095. [PMID: 26632724 PMCID: PMC5058993 DOI: 10.1097/md.0000000000002095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The goal of this study was to detect the long-term effect of shunting on the integrity of white matter in young children with hydrocephalus.The authors reported the case of a 6-month-old boy with hydrocephalus who was evaluated by diffusion tensor imaging (DTI) before and after a shunt operation.When compared with normal children, the structures of the corpus callosum, internal capsule, and corona radiata in the patient showed a decrease in fractional anisotropy and an increase in radial diffusivity values before the shunt operation. Following successful cerebrospinal fluid shunting, long-term follow-up DTI demonstrated a trend toward normalization of the fractional anisotropy and radial diffusivity values.Shunt treatment can prevent further damage to the brain and grossly reconstitute the distorted anatomy. DTI could be a useful tool in detecting longitudinal changes after a shunt operation. Further studies involving larger case numbers are needed to detect the long-term effect of shunting on the brains of children with hydrocephalus.
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Affiliation(s)
- Yongxin Li
- From the Institute of Clinical Anatomy, Southern Medical University, Guangzhou (YL, YW, JW, HG, BZ, WH); Department of Pediatric Radiology, Shenzhen Children Hospital (CZ); Department of Pediatric Neurosurgery, Shenzhen Children Hospital (ZT); and Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China (HZ)
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Abnormal structural connectivity in the brain networks of children with hydrocephalus. NEUROIMAGE-CLINICAL 2015; 8:483-92. [PMID: 26106573 PMCID: PMC4474092 DOI: 10.1016/j.nicl.2015.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/18/2015] [Accepted: 04/26/2015] [Indexed: 12/21/2022]
Abstract
Increased intracranial pressure and ventriculomegaly in children with hydrocephalus are known to have adverse effects on white matter structure. This study seeks to investigate the impact of hydrocephalus on topological features of brain networks in children. The goal was to investigate structural network connectivity, at both global and regional levels, in the brains in children with hydrocephalus using graph theory analysis and diffusion tensor tractography. Three groups of children were included in the study (29 normally developing controls, 9 preoperative hydrocephalus patients, and 17 postoperative hydrocephalus patients). Graph theory analysis was applied to calculate the global network measures including small-worldness, normalized clustering coefficients, normalized characteristic path length, global efficiency, and modularity. Abnormalities in regional network parameters, including nodal degree, local efficiency, clustering coefficient, and betweenness centrality, were also compared between the two patients groups (separately) and the controls using two tailed t-test at significance level of p < 0.05 (corrected for multiple comparison). Children with hydrocephalus in both the preoperative and postoperative groups were found to have significantly lower small-worldness and lower normalized clustering coefficient than controls. Children with hydrocephalus in the postoperative group were also found to have significantly lower normalized characteristic path length and lower modularity. At regional level, significant group differences (or differences at trend level) in regional network measures were found between hydrocephalus patients and the controls in a series of brain regions including the medial occipital gyrus, medial frontal gyrus, thalamus, cingulate gyrus, lingual gyrus, rectal gyrus, caudate, cuneus, and insular. Our data showed that structural connectivity analysis using graph theory and diffusion tensor tractography is sensitive to detect abnormalities of brain network connectivity associated with hydrocephalus at both global and regional levels, thus providing a new avenue for potential diagnosis and prognosis tool for children with hydrocephalus.
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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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Jurcoane A, Keil F, Szelenyi A, Pfeilschifter W, Singer OC, Hattingen E. Directional diffusion of corticospinal tract supports therapy decisions in idiopathic normal-pressure hydrocephalus. Neuroradiology 2013; 56:5-13. [PMID: 24158631 DOI: 10.1007/s00234-013-1289-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/07/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Gait disturbance in patients with idiopathic normal pressure hydrocephalus (iNPH) may be caused by alterations of the corticospinal tract that we aimed to measure with diffusion tensor imaging (DTI). The directional diffusion parameters axial diffusivity and fractional anisotropy (FA) reflect axon integrity, whereas mean diffusivity, radial diffusivity and magnetization transfer ratio (MTR) reflect myelin content. METHODS Twenty-six patients with probable iNPH were grouped into drainage responders (n = 12) and drainage non-responders (n = 14) according to their improvement on gait assessment tests after a 3-day lumbar CSF drainage. We measured DTI and MTR of the corticospinal tract and, as reference, of the superior longitudinal fascicle before and after CSF withdrawal in iNPH and in ten age-matched controls. Drainage responders were re-examined after ventricoperitoneal shunting. Differences before any intervention and changes upon CSF withdrawal were evaluated. RESULTS Axial diffusivity in corticospinal tract and superior longitudinal fascicle was higher in both patient groups compared to controls (p < 0.001). Only in the corticospinal tract of drainage responders was FA higher compared to controls, and both FA and axial diffusivity decreased after shunting. For axial diffusivity upon CSF drainage, a decrease of >0.7 % discriminated drainage responders from drainage non-responders with 82 % sensitivity, and a decrease of >1 % predicted overall improvement after shunting with 87.5 % sensitivity and 75 % specificity. The specificity to discriminate responders/non-responders was low for all DTI values (max. 69 % for FA values). CONCLUSION High values of directional diffusion parameters in the corticospinal tract are found in iNPH patients indicating affection of its axons. Increased values and their decrease upon CSF drainage may facilitate treatment decisions in clinically uncertain cases.
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Affiliation(s)
- Alina Jurcoane
- Department of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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Jang SH, Choi BY, Chang CH, Jung YJ, Byun WM, Kim SH, Yeo SS. The effects of hydrocephalus on the periventricular white matter in intracerebral hemorrhage: a diffuser tensor imaging study. Int J Neurosci 2013; 123:420-4. [DOI: 10.3109/00207454.2012.763164] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Scheel M, Diekhoff T, Sprung C, Hoffmann KT. Diffusion tensor imaging in hydrocephalus--findings before and after shunt surgery. Acta Neurochir (Wien) 2012; 154:1699-706. [PMID: 22610531 DOI: 10.1007/s00701-012-1377-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/01/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate changes in diffusion tensor imaging (DTI)-derived parameters in patients with hydrocephalus (HC) before and several weeks after shunt surgery. METHODS Thirteen HC patients were examined with DTI before and after shunt surgery. In a combined region of interest and whole brain voxel-based analysis, different DTI parameters were compared with an age-matched control group. RESULTS Alteration of DTI parameters in HC patients and changes after shunt surgery are regionally different. HC patients show an increase in fractional anisotropy values based on increases in parallel diffusivity in the corticospinal tract. On the other hand, reduced fractional anisotropy values are found in the corpus callosum of HC patients. Following shunt surgery, all DTI parameters showed a trend towards normalization, yet differences to healthy control subjects remained. CONCLUSION Our results show that DTI parameter changes are regionally dependent and need a careful interpretation of the underlying diffusivities to serve as a diagnostic or follow-up measure in patients with hydrocephalus.
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Affiliation(s)
- Michael Scheel
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Hong JH, Choi BY, Chang CH, Kim SH, Jung YJ, Byun WM, Jang SH. Injuries of the Cingulum and Fornix After Rupture of an Anterior Communicating Artery Aneurysm. Neurosurgery 2011; 70:819-23. [PMID: 21937938 DOI: 10.1227/neu.0b013e3182367124] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
After rupture of an anterior communicating artery (ACoA) aneurysm, the anterior cingulum and the fornix can be vulnerable to injury. However, very little is known about this topic.
OBJECTIVE:
To investigate injuries of the cingulum and fornix in patients with an ACoA aneurysm rupture with diffusion tensor tractography.
METHODS:
Eleven consecutive patients with an ACoA aneurysm rupture and 11 age- and sex-matched normal control subjects were recruited. Diffusion tensor imaging was scanned at an average of 54.1 days (range, 29–97 days) after onset of ACoA aneurysm rupture.
RESULTS:
We found that 6 (54.5%) and 7 (63.6%) of 11 patients revealed no trajectory of the anterior cingulum and the fornical body on diffusion tensor tractography, respectively. In terms of diffusion tensor imaging parameters, we found that the fractional anisotropy value and tract volume of the cingulum and fornix were decreased (P < .05) and that mean diffusivity values were increased (P < .05), except for those of the left fornix, which showed no difference (P > .05).
CONCLUSION:
We found injuries of the cingulum and fornix in patients with an ACoA aneurysm rupture. It is our belief that sustained memory impairment of patients with an ACoA aneurysm rupture might be related to injury of the cingulum and fornix. Therefore, we recommend evaluation of the cingulum and fornix with diffusion tensor tractography for patients with an ACoA aneurysm rupture.
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Affiliation(s)
- Ji Heon Hong
- Department of Physical Therapy, Sun Moon University, Asan-si, Chungnam, Republic of Korea
| | - Byung Yeon Choi
- Department of Neurosurgery, College of Medicine, Yeungnam University, Taegu, Republic of Korea
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, Taegu, Republic of Korea
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Taegu, Republic of Korea
| | - Young Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, Taegu, Republic of Korea
| | - Woo Mok Byun
- Department of Diagnostic Radiology, College of Medicine, Yeungnam University, Taegu, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea
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Yeo SS, Choi BY, Chang CH, Jung YJ, Ahn SH, Son SM, Byun WM, Jang SH. Periventricular White Matter Injury by Primary Intraventricular Hemorrhage: A Diffusion Tensor Imaging Study. Eur Neurol 2011; 66:235-41. [DOI: 10.1159/000330942] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 07/04/2011] [Indexed: 11/19/2022]
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