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Currà A, Gasbarrone R, Gargiulo P, Rughetti A, Peschillo S, Trompetto C, Puce L, Marinelli L, Fattapposta F, Bragazzi NL, Missori P. Frequency of brain ventricular enlargement among patients with diabetes mellitus. Diabetes Res Clin Pract 2024; 210:111644. [PMID: 38552909 DOI: 10.1016/j.diabres.2024.111644] [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: 02/05/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/01/2024]
Abstract
AIMS To determine the prevalence of dilated ventricles and concomitant high blood glucose measures. METHODS We retrieved blood glucose measures from the emergency department database and selected a subgroup of individuals having both the radiological marker Evans' index (EI) values and blood glucose measures. RESULTS Out of 1221 consecutive patients submitted to axial Computed Tomography scans, a blood glucose measure was detected in 841 individuals. 176 scans (21 %) showed an EI > 0.30. According to the blood glucose categorization, diabetic patients were 104 (12 %), 25 of them (24 %) were dilated (mean EI 0.33). The age difference between dilated and not-dilated ventricles is about ten years in not-diabetic participants, whereas it is five years in diabetic participants. The age difference between dilated and not-dilated ventricles is about 10 years in diabetic men, whereas it zero in diabetic women. CONCLUSIONS Pathological ventricular enlargement is more frequent in men and in the elderly. In diabetic patients (especially women), the cerebral ventricles enlarge faster than in non-diabetic individuals. Age, sex, and diabetes may interact in determining how cerebral ventricle size changes over time, especially in diabetic women, making routine brain imaging advisable in these patients after the age of 70 years.
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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, Italy
| | - Riccardo Gasbarrone
- Department of Chemical Engineering, Materials & Environment, Sapienza University of Rome, Rome, Italy
| | - Patrizia Gargiulo
- Department of Experimental Medicine, Endocrinology-Pituitary Disease, "Sapienza" University of Rome, Rome, Italy
| | - Aurelia Rughetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | | | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Italy; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Francesco Fattapposta
- Department of Human Neuroscience, Neurology, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
| | - Paolo Missori
- Department of Human Neuroscience, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
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Le Rhun E, Devos P, Seystahl K, Jongen JLM, Gramatzki D, Roth P, Van Den Bent MJ, Regli L, Brandsma D, Weller M. Prognostic Role of Ventricular Size and Its Dynamics in Patients With Leptomeningeal Metastasis From Solid Tumors. Neurology 2024; 102:e207959. [PMID: 38335471 PMCID: PMC10834142 DOI: 10.1212/wnl.0000000000207959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/11/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Hydrocephalus is a common radiologic sign in patients with leptomeningeal metastasis (LM) from solid tumors which can be assessed using the Evans index (EI). Here, we explored the prognostic value of ventricular size in LM. METHODS We identified patients with LM from solid tumors by chart review at 3 academic hospitals to explore the prognostic associations of the EI at diagnosis, first follow-up, and progression. RESULTS We included 113 patients. The median age was 58.3 years (interquartile range [IQR] 46.1-65.8), 41 patients (36%) were male, and 72 patients (64%) were female. The most frequent cancers were lung cancer (n = 39), breast cancer (n = 36), and melanoma (n = 23). The median EI at baseline was 0.28 (IQR 0.26-0.31); the EI value was 0.27 or more in 67 patients (59%) and 0.30 or more in 37 patients (33%). Among patients with MRI follow-up, the EI increased by 0.01 or more in 16 of 31 patients (52%), including 8 of 30 patients (30%) without and 10 of 17 patients (59%) with LM progression at first follow-up. At LM progression, an increase of EI of 0.01 or more was noted in 18 of 34 patients (53%). The median survival was 2.9 months (IQR 1-7.2). Patients with a baseline EI below 0.27 had a longer survival than those with an EI of 0.27 or more (5.3 months, IQR 2.4-10.8, vs 1.3 months, IQR 0.6-4.1) (HR 1.70, 95% CI 1.135-2.534, p = 0.0099). The median survival was 3.7 months (IQR 1.4-8.3) with an EI below 0.30 vs 1.8 months (IQR 0.8-4.1) with an EI of 0.30 or more (HR 1.40, 95% CI 0.935-1.243, p = 0.1113). Among patients with follow-up scans available, the overall survival was 9.4 months (IQR 5.6-21.0) for patients with stable or decreased EI at first follow-up as opposed to 5.6 months (IQR 2.5-10.5) for those with an increase in the EI (HR 1.08, 95% CI 0.937-1.243; p = 0.300). DISCUSSION The EI at baseline is prognostic in LM. An increase of EI during follow-up may be associated with inferior LM progression-free survival. Independent validation cohorts with larger sample size and evaluation of confounding factors will help to better define the clinical utility of EI assessments in LM.
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Affiliation(s)
- Emilie Le Rhun
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Patrick Devos
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Katharina Seystahl
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Joost L M Jongen
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Dorothee Gramatzki
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Patrick Roth
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Martin J Van Den Bent
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Luca Regli
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Dieta Brandsma
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
| | - Michael Weller
- From the Departments of Neurosurgery (E.L.R., L.R.) and Neurology (E.L.R., K.S., D.G., P.R., M.W.), University Hospital and University of Zurich, Switzerland; Lillometrics (P.D.), Univ. Lille - CHU Lille; Brain Tumor Center at Erasmus MC Cancer Institute (J.L.J., M.J.V.D.B.), Erasmus University Hospital Rotterdam, the Netherlands; and Department of Neuro-Oncology (D.B.), Netherlands Cancer Institute, Amsterdam
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Ziegelitz D, Hellström P, Björkman-Burtscher IM, Agerskov S, Stevens-Jones O, Farahmand D, Tullberg M. Evaluation of a Fully Automated Method for Ventricular Volume Segmentation Before and After Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2024; 181:e303-e311. [PMID: 37838163 DOI: 10.1016/j.wneu.2023.10.045] [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: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Determination of the ventricle size in idiopathic normal pressure hydrocephalus (iNPH) is essential for diagnosis and follow-up of shunt results. Fully automated segmentation methods are anticipated to optimize the accuracy and time efficiency of ventricular volume measurements. We evaluated the accuracy of preoperative and postoperative ventricular volume measurements in iNPH by a magnetic resonance imaging (MRI)-based licensed software for fully automated quantitative assessment. METHODS Forty-eight patients diagnosed with iNPH were retrospectively analyzed. All patients received a ventriculoperitoneal shunt and had symptom grading and routine MRI preoperatively and 3-6 months postoperatively. Ventricular volumes, generated by fully automated T1-weighted imaging volume sequence segmentation, were compared with semiautomatic measurements and routine radiologic reports. The relation of postoperative ventricular size change to clinical response was evaluated. RESULTS Fully automated segmentation was achieved in 95% of the MRIs, but showed various rates of 8 minor segmentation errors. The correlation between both segmentation methods was very strong (r >0.9) and the agreement very good using Bland-Altman analyses. The ventricular volumes differed significantly between semiautomated and fully automated segmentations and between preoperative and postoperative MRI. The fully automated method systematically overestimated the ventricles by a median 15 mL preoperatively and 14 mL postoperatively; hence, the magnitudes of volume changes were equivalent. Routine radiologic reports of ventricular size changes were inaccurate in 51% and lacked association with treatment response. Objectively measured ventricular volume changes correlated moderately with postoperative clinical improvement. CONCLUSIONS A fully automated volumetric method permits reliable evaluation of preoperative ventriculomegaly and postoperative ventricular volume change in idiopathic normal pressure hydrocephalus.
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Affiliation(s)
- Doerthe Ziegelitz
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Hellström
- Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Agerskov
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Stevens-Jones
- Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Farahmand
- Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Tullberg
- Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Haller S, Montandon ML, Rodriguez C, Herrmann FR, Giannakopoulos P. Automatic MRI volumetry in asymptomatic cases at risk for normal pressure hydrocephalus. Front Aging Neurosci 2023; 15:1242158. [PMID: 38020768 PMCID: PMC10655029 DOI: 10.3389/fnagi.2023.1242158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
The occurrence of significant Alzheimer's disease (AD) pathology was described in approximately 30% of normal pressure hydrocephalus (NPH) cases, leading to the distinction between neurodegenerative and idiopathic forms of this disorder. Whether or not there is a specific MRI signature of NPH remains a matter of debate. The present study focuses on asymptomatic cases at risk for NPH as defined with automatic machine learning tools and combines automatic MRI assessment of cortical and white matter volumetry, risk of AD (AD-RAI), and brain age gap estimation (BrainAge). Our hypothesis was that brain aging and AD process-independent volumetric changes occur in asymptomatic NPH-positive cases. We explored the volumetric changes in normal aging-sensitive (entorhinal cortex and parahippocampal gyrus/PHG) and AD-signature areas (hippocampus), four control cortical areas (frontal, parietal, occipital, and temporal), and cerebral and cerebellar white matter in 30 asymptomatic cases at risk for NPH (NPH probability >30) compared to 30 NPH-negative cases (NPH probability <5) with preserved cognition. In univariate regression models, NPH positivity was associated with decreased volumes in the hippocampus, parahippocampal gyrus (PHG), and entorhinal cortex bilaterally. The strongest negative association was found in the left hippocampus that persisted when adjusting for AD-RAI and Brain Age values. A combined model including the three parameters explained 36.5% of the variance, left hippocampal volumes, and BrainAge values, which remained independent predictors of the NPH status. Bilateral PHG and entorhinal cortex volumes were negatively associated with NPH-positive status in univariate models but this relationship did not persist when adjusting for BrainAge, the latter remaining the only predictor of the NPH status. We also found a negative association between bilateral cerebral and cerebellar white matter volumes and NPH status that persisted after controlling for AD-RAI or Brain Age values, explaining between 50 and 65% of its variance. These observations support the idea that in cases at risk for NPH, as defined by support vector machine assessment of NPH-related MRI markers, brain aging-related and brain aging and AD-independent volumetric changes coexist. The latter concerns volume loss in restricted hippocampal and white matter areas that could be considered as the MRI signature of idiopathic forms of NPH.
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Affiliation(s)
- Sven Haller
- CIMC - Centre d’Imagerie Médicale de Cornavin, Geneva, Switzerland
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cristelle Rodriguez
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - François R. Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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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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Liu S, Chen P, Yang H, Xie T, Liu T, Li C, Yang L, Li Z, Huang J, Gao Y, Xie Q, Yu Y, Hu F, Zhang X. Role of endoscopic third ventriculostomy in patients undergoing resection of pulvinar area lesions: Preliminary clinical results. J Clin Neurosci 2023; 117:61-67. [PMID: 37774635 DOI: 10.1016/j.jocn.2023.09.018] [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: 08/08/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Patients with pulvinar area lesions may develop hydrocephalus at any stage. The role of endoscopic third ventriculostomy (ETV) in this setting remains unclear. METHOD We retrospectively enrolled 15 patients with a mean age of 43 years who underwent endoscopic resection of pulvinar area lesions using the supracerebellar infratentorial approach (SCITA). We compared the different modalities of hydrocephalus management and their outcomes. RESULTS Nine of 15 patients (60.0%) had preoperative obstructive hydrocephalus. Five patients underwent ETV before tumor resection, and none developed postoperative hydrocephalus. Four patients underwent one-stage surgery for tumor removal, and one patient with a polymorphous low-grade neuroepithelial tumor of the young required postoperative ETV. Another patient with diffuse astrocytoma and hydrocephalus underwent concurrent lamina terminalis fenestration and endoscopic resection via the SCITA, which resulted in the resolution of hydrocephalus. The preoperative ETV group had no major postoperative complications, while the non-ETV group had three (0/5 vs. 3/4, P = 0.048). The ETV group also had a shorter intensive care unit stay; however, the difference was not significant (1.2 vs. 2.8; P = 0.188). ETV was effective in alleviating symptoms of postoperative hydrocephalus in patients with midbrain-invading tumors. CONCLUSION Endoscopic surgery via the SCITA can address both tumor and hydrocephalus issues in some cases but has a higher surgical risk and postoperative hydrocephalus rate. Preoperative ETV can prevent these complications and improve postoperative outcomes.
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Affiliation(s)
- Shuang Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pin Chen
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hantao Yang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Xie
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tengfei Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liangliang Yang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zeyang Li
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinlong Huang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Gao
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiang Xie
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Yu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fan Hu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China; Digital Medical Research Center, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer-Assisted Intervention, Shanghai, China.
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7
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Songsaeng D, Nava-apisak P, Wongsripuemtet J, Kingchan S, Angkoondittaphong P, Phawaphutanon P, Supratak A. The Diagnostic Accuracy of Artificial Intelligence in Radiological Markers of Normal-Pressure Hydrocephalus (NPH) on Non-Contrast CT Scans of the Brain. Diagnostics (Basel) 2023; 13:2840. [PMID: 37685378 PMCID: PMC10486480 DOI: 10.3390/diagnostics13172840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Diagnosing normal-pressure hydrocephalus (NPH) via non-contrast computed tomography (CT) brain scans is presently a formidable task due to the lack of universally agreed-upon standards for radiographic parameter measurement. A variety of radiological parameters, such as Evans' index, narrow sulci at high parietal convexity, Sylvian fissures' dilation, focally enlarged sulci, and more, are currently measured by radiologists. This study aimed to enhance NPH diagnosis by comparing the accuracy, sensitivity, specificity, and predictive values of radiological parameters, as evaluated by radiologists and AI methods, utilizing cerebrospinal fluid volumetry. Results revealed a sensitivity of 77.14% for radiologists and 99.05% for AI, with specificities of 98.21% and 57.14%, respectively, in diagnosing NPH. Radiologists demonstrated NPV, PPV, and an accuracy of 82.09%, 97.59%, and 88.02%, while AI reported 98.46%, 68.42%, and 77.42%, respectively. ROC curves exhibited an area under the curve of 0.954 for radiologists and 0.784 for AI, signifying the diagnostic index for NPH. In conclusion, although radiologists exhibited superior sensitivity, specificity, and accuracy in diagnosing NPH, AI served as an effective initial screening mechanism for potential NPH cases, potentially easing the radiologists' burden. Given the ongoing AI advancements, it is plausible that AI could eventually match or exceed radiologists' diagnostic prowess in identifying hydrocephalus.
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Affiliation(s)
- Dittapong Songsaeng
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (D.S.)
| | - Poonsuta Nava-apisak
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (D.S.)
| | - Jittsupa Wongsripuemtet
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (D.S.)
| | - Siripra Kingchan
- Faculty of Information and Communication Technology, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand
| | - Phuriwat Angkoondittaphong
- Faculty of Information and Communication Technology, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand
| | - Phattaranan Phawaphutanon
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (D.S.)
| | - Akara Supratak
- Faculty of Information and Communication Technology, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand
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8
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Sabeti M, Alikhani S, Shakoor M, Boostani R, Moradi E. Automatic determination of ventricular indices in hydrocephalic pediatric brain CT scan. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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9
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Morphological evaluation of the normal and hydrocephalic third ventricle on cranial magnetic resonance imaging in children: a retrospective study. Pediatr Radiol 2023; 53:282-296. [PMID: 35994062 DOI: 10.1007/s00247-022-05475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/17/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Third ventricle morphological changes reflect changes in the ventricular system in pediatric hydrocephalus, so visual inspection of the third ventricle shape is standard practice. However, normal pediatric reference data are not available. OBJECTIVE To investigate both the normal development of the third ventricle in the 0-18-year age group and changes in its biometry due to hydrocephalus. MATERIALS AND METHODS For this retrospective study, we selected individuals ages 0-18 years who had magnetic resonance imaging (MRI) from 2012 to 2020. We included 700 children (331 girls) who had three-dimensional (3-D) T1-weighted sequences without and 25 with hydrocephalus (11 girls). We measured the distances between the anatomical structures limiting the third ventricle by dividing the third ventricle into anterior and posterior regions. We made seven linear measurements and three index calculations using 3DSlicer and MRICloud pipeline, and we analyzed the results of 23 age groups in normal and hydrocephalic patients using SPSS (v. 23). RESULTS Salient findings are: (1) The posterior part of the third ventricle is more affected by both developmental and hydrocephalus-related changes. (2) For third ventricle measurements, gender was insignificant while age was significant. (3) Normal third ventricular volumetric development showed a segmental increase in the 0-18 age range. The hydrocephalic third ventricle volume cut-off value in this age group was 3 cm3. CONCLUSION This study describes third ventricle morphometry using a linear measurement method. The ratios defined in the midsagittal plane were clinically useful for diagnosing the hydrocephalic third ventricle. The linear and volumetric reference data and ratios are expected to help increase diagnostic accuracy in distinguishing normal and hydrocephalic third ventricles.
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10
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Lucia K, Reitz S, Hattingen E, Steinmetz H, Seifert V, Czabanka M. Predictors of clinical outcomes in space-occupying cerebellar infarction undergoing suboccipital decompressive craniectomy. Front Neurol 2023; 14:1165258. [PMID: 37139059 PMCID: PMC10149688 DOI: 10.3389/fneur.2023.1165258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Despite current clinical guidelines recommending suboccipital decompressive craniectomy (SDC) in cerebellar infarction when patients present with neurological deterioration, the precise definition of neurological deterioration remains unclear and accurate timing of SDC can be challenging. The current study aimed at characterizing whether clinical outcomes can be predicted by the GCS score immediately prior to SDC and whether higher GCS scores are associated with better clinical outcomes. Methods In a single-center, retrospective analysis of 51 patients treated with SDC for space-occupying cerebellar infarction, clinical and imaging data were evaluated at the time points of symptom onset, hospital admission, and preoperatively. Clinical outcomes were measured by the mRS. Preoperative GCS scores were stratified into three groups (GCS, 3-8, 9-11, and 12-15). Univariate and multivariate Cox regression analyses were performed using clinical and radiological parameters as predictors of clinical outcomes. Results In cox regression analysis GCS scores of 12-15 at surgery were significant predictors of positive clinical outcomes (mRS, 1-2). For GCS scores of 3-8 and 9-11, no significant increase in proportional hazard ratios was observed. Negative clinical outcomes (mRS, 3-6) were associated with infarct volume above 6.0 cm3, tonsillar herniation, brainstem compression, and a preoperative GCS score of 3-8 [HR, 2.386 (CI, 1.160-4.906); p = 0.018]. Conclusion Our preliminary findings suggest that SDC should be considered in patients with infarct volumes above 6.0 cm3 and with GCS between 12 and 15, as these patients may show better long-term outcomes than those in whom surgery is delayed until a GCS score below 11.
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Affiliation(s)
- Kristin Lucia
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Sarah Reitz
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital, Frankfurt, Germany
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
- *Correspondence: Marcus Czabanka
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11
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Huang Y, Moreno R, Malani R, Meng A, Swinburne N, Holodny AI, Choi Y, Rusinek H, Golomb JB, George A, Parra LC, Young RJ. Deep Learning Achieves Neuroradiologist-Level Performance in Detecting Hydrocephalus Requiring Treatment. J Digit Imaging 2022; 35:1662-1672. [PMID: 35581409 PMCID: PMC9712867 DOI: 10.1007/s10278-022-00654-3] [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: 11/05/2021] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022] Open
Abstract
In large clinical centers a small subset of patients present with hydrocephalus that requires surgical treatment. We aimed to develop a screening tool to detect such cases from the head MRI with performance comparable to neuroradiologists. We leveraged 496 clinical MRI exams collected retrospectively at a single clinical site from patients referred for any reason. This diagnostic dataset was enriched to have 259 hydrocephalus cases. A 3D convolutional neural network was trained on 16 manually segmented exams (ten hydrocephalus) and subsequently used to automatically segment the remaining 480 exams and extract volumetric anatomical features. A linear classifier of these features was trained on 240 exams to detect cases of hydrocephalus that required treatment with surgical intervention. Performance was compared to four neuroradiologists on the remaining 240 exams. Performance was also evaluated on a separate screening dataset of 451 exams collected from a routine clinical population to predict the consensus reading from four neuroradiologists using images alone. The pipeline was also tested on an external dataset of 31 exams from a 2nd clinical site. The most discriminant features were the Magnetic Resonance Hydrocephalic Index (MRHI), ventricle volume, and the ratio between ventricle and brain volume. At matching sensitivity, the specificity of the machine and the neuroradiologists did not show significant differences for detection of hydrocephalus on either dataset (proportions test, p > 0.05). ROC performance compared favorably with the state-of-the-art (AUC 0.90-0.96), and replicated in the external validation. Hydrocephalus cases requiring treatment can be detected automatically from MRI in a heterogeneous patient population based on quantitative characterization of brain anatomy with performance comparable to that of neuroradiologists.
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Affiliation(s)
- Yu Huang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Raquel Moreno
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Rachna Malani
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Alicia Meng
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Nathaniel Swinburne
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Andrei I. Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Ye Choi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Henry Rusinek
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY 10016 USA
- Department of Psychiatry, Grossman School of Medicine, New York University, New York, NY 10016 USA
| | - James B. Golomb
- Department of Psychiatry, Grossman School of Medicine, New York University, New York, NY 10016 USA
- Department of Neurology, Grossman School of Medicine, New York University, New York, NY 10016 USA
| | - Ajax George
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY 10016 USA
| | - Lucas C. Parra
- Department of Biomedical Engineering, City College of New York, 160 Convent Ave, Steinman Hall Room 401, New York, NY 10031 USA
| | - Robert J. Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
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12
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Wang F, Lai Y, Pan Y, Li H, Liu Q, Sun B. A systematic review of brain morphometry related to deep brain stimulation outcome in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:130. [PMID: 36224189 PMCID: PMC9556527 DOI: 10.1038/s41531-022-00403-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
While the efficacy of deep brain stimulation (DBS) is well-established in Parkinson’s Disease (PD), the benefit of DBS varies across patients. Using imaging features for outcome prediction offers potential in improving effectiveness, whereas the value of presurgical brain morphometry, derived from the routinely used imaging modality in surgical planning, remains under-explored. This review provides a comprehensive investigation of links between DBS outcomes and brain morphometry features in PD. We systematically searched PubMed and Embase databases and retrieved 793 articles, of which 25 met inclusion criteria and were reviewed in detail. A majority of studies (24/25), including 1253 of 1316 patients, focused on the outcome of DBS targeting the subthalamic nucleus (STN), while five studies included 57 patients receiving globus pallidus internus (GPi) DBS. Accumulated evidence showed that the atrophy of motor cortex and thalamus were associated with poor motor improvement, other structures such as the lateral-occipital cortex and anterior cingulate were also reported to correlated with motor outcome. Regarding non-motor outcomes, decreased volume of the hippocampus was reported to correlate with poor cognitive outcomes. Structures such as the thalamus, nucleus accumbens, and nucleus of basalis of Meynert were also reported to correlate with cognitive functions. Caudal middle frontal cortex was reported to have an impact on postsurgical psychiatric changes. Collectively, the findings of this review emphasize the utility of brain morphometry in outcome prediction of DBS for PD. Future efforts are needed to validate the findings and demonstrate the feasibility of brain morphometry in larger cohorts.
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Affiliation(s)
- Fengting Wang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Lai
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyang Li
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qimin Liu
- grid.152326.10000 0001 2264 7217Department of Psychology and Human Development, Vanderbilt University, Nashville, USA
| | - Bomin Sun
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Zhou X, Ye Q, Yang X, Chen J, Ma H, Xia J, Del Ser J, Yang G. AI-based medical e-diagnosis for fast and automatic ventricular volume measurement in patients with normal pressure hydrocephalus. Neural Comput Appl 2022; 35:1-10. [PMID: 35228779 PMCID: PMC8866920 DOI: 10.1007/s00521-022-07048-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022]
Abstract
Based on CT and MRI images acquired from normal pressure hydrocephalus (NPH) patients, using machine learning methods, we aim to establish a multimodal and high-performance automatic ventricle segmentation method to achieve an efficient and accurate automatic measurement of the ventricular volume. First, we extract the brain CT and MRI images of 143 definite NPH patients. Second, we manually label the ventricular volume (VV) and intracranial volume (ICV). Then, we use the machine learning method to extract features and establish automatic ventricle segmentation model. Finally, we verify the reliability of the model and achieved automatic measurement of VV and ICV. In CT images, the Dice similarity coefficient (DSC), intraclass correlation coefficient (ICC), Pearson correlation, and Bland-Altman analysis of the automatic and manual segmentation result of the VV were 0.95, 0.99, 0.99, and 4.2 ± 2.6, respectively. The results of ICV were 0.96, 0.99, 0.99, and 6.0 ± 3.8, respectively. The whole process takes 3.4 ± 0.3 s. In MRI images, the DSC, ICC, Pearson correlation, and Bland-Altman analysis of the automatic and manual segmentation result of the VV were 0.94, 0.99, 0.99, and 2.0 ± 0.6, respectively. The results of ICV were 0.93, 0.99, 0.99, and 7.9 ± 3.8, respectively. The whole process took 1.9 ± 0.1 s. We have established a multimodal and high-performance automatic ventricle segmentation method to achieve efficient and accurate automatic measurement of the ventricular volume of NPH patients. This can help clinicians quickly and accurately understand the situation of NPH patient's ventricles.
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Affiliation(s)
- Xi Zhou
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen Second People’s Hospital, 3002 SunGang Road West, Shenzhen, 518035 Guangdong Province China
| | - Qinghao Ye
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA USA
| | - Xiaolin Yang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen Second People’s Hospital, 3002 SunGang Road West, Shenzhen, 518035 Guangdong Province China
| | - Jiakun Chen
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen Second People’s Hospital, 3002 SunGang Road West, Shenzhen, 518035 Guangdong Province China
| | - Haiqin Ma
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen Second People’s Hospital, 3002 SunGang Road West, Shenzhen, 518035 Guangdong Province China
| | - Jun Xia
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen Second People’s Hospital, 3002 SunGang Road West, Shenzhen, 518035 Guangdong Province China
| | - Javier Del Ser
- University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain
- TECNALIA, Basque Research and Technology Alliance (BRTA), 48160 Derio, Spain
| | - Guang Yang
- Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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14
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Largent A, De Asis-Cruz J, Kapse K, Barnett SD, Murnick J, Basu S, Andersen N, Norman S, Andescavage N, Limperopoulos C. Automatic brain segmentation in preterm infants with post-hemorrhagic hydrocephalus using 3D Bayesian U-Net. Hum Brain Mapp 2022; 43:1895-1916. [PMID: 35023255 PMCID: PMC8933325 DOI: 10.1002/hbm.25762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Post‐hemorrhagic hydrocephalus (PHH) is a severe complication of intraventricular hemorrhage (IVH) in very preterm infants. PHH monitoring and treatment decisions rely heavily on manual and subjective two‐dimensional measurements of the ventricles. Automatic and reliable three‐dimensional (3D) measurements of the ventricles may provide a more accurate assessment of PHH, and lead to improved monitoring and treatment decisions. To accurately and efficiently obtain these 3D measurements, automatic segmentation of the ventricles can be explored. However, this segmentation is challenging due to the large ventricular anatomical shape variability in preterm infants diagnosed with PHH. This study aims to (a) propose a Bayesian U‐Net method using 3D spatial concrete dropout for automatic brain segmentation (with uncertainty assessment) of preterm infants with PHH; and (b) compare the Bayesian method to three reference methods: DenseNet, U‐Net, and ensemble learning using DenseNets and U‐Nets. A total of 41 T2‐weighted MRIs from 27 preterm infants were manually segmented into lateral ventricles, external CSF, white and cortical gray matter, brainstem, and cerebellum. These segmentations were used as ground truth for model evaluation. All methods were trained and evaluated using 4‐fold cross‐validation and segmentation endpoints, with additional uncertainty endpoints for the Bayesian method. In the lateral ventricles, segmentation endpoint values for the DenseNet, U‐Net, ensemble learning, and Bayesian U‐Net methods were mean Dice score = 0.814 ± 0.213, 0.944 ± 0.041, 0.942 ± 0.042, and 0.948 ± 0.034 respectively. Uncertainty endpoint values for the Bayesian U‐Net were mean recall = 0.953 ± 0.037, mean negative predictive value = 0.998 ± 0.005, mean accuracy = 0.906 ± 0.032, and mean AUC = 0.949 ± 0.031. To conclude, the Bayesian U‐Net showed the best segmentation results across all methods and provided accurate uncertainty maps. This method may be used in clinical practice for automatic brain segmentation of preterm infants with PHH, and lead to better PHH monitoring and more informed treatment decisions.
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Affiliation(s)
- Axel Largent
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Josepheen De Asis-Cruz
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Kushal Kapse
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Scott D Barnett
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Jonathan Murnick
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Sudeepta Basu
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Nicole Andersen
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Stephanie Norman
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Nickie Andescavage
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA.,Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA.,Departments of Radiology and Pediatrics, George Washington University, Washington, District of Columbia, USA.,Neurology School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
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15
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Zhou X, Xia J. Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review. Front Aging Neurosci 2022; 13:783092. [PMID: 35087391 PMCID: PMC8787286 DOI: 10.3389/fnagi.2021.783092] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
With an ever-growing aging population, the prevalence of normal pressure hydrocephalus (NPH) is increasing. Clinical symptoms of NPH include cognitive impairment, gait disturbance, and urinary incontinence. Surgery can improve symptoms, which leads to the disease's alternative name: treatable dementia. The Evans index (EI), defined as the ratio of the maximal width of the frontal horns to the maximum inner skull diameter, is the most commonly used index to indirectly assess the condition of the ventricles in NPH patients. EI measurement is simple, fast, and does not require any special software; in clinical practice, an EI >0.3 is the criterion for ventricular enlargement. However, EI's measurement methods, threshold setting, correlation with ventricle volume, and even its clinical value has been questioned. Based on the EI, the z-EI and anteroposterior diameter of the lateral ventricle index were derived and are discussed in this review.
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16
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Jang H, Park YH, Choe YS, Kang SH, Kang ES, Lee S, Seo SW, Kim HJ, Na DL. Amyloid Positive Hydrocephalus: A Hydrocephalic Variant of Alzheimer's Disease? J Alzheimers Dis 2021; 85:1467-1479. [PMID: 34958024 DOI: 10.3233/jad-215110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) and normal pressure hydrocephalus (NPH) commonly coexist. OBJECTIVE We aimed to characterize an overlapping syndrome of AD and NPH that presents with gait disturbance, ventriculomegaly on magnetic resonance imaging, and significant amyloid deposition on positron emission tomography (PET). METHODS Of 114 patients who underwent cerebrospinal fluid (CSF) drainage for a possible diagnosis of NPH between 2015 and 2020 in Samsung Medical Center, we identified 24 patients (21.1%) with the NPH patients with amyloid deposition on PET, which we referred to as hydrocephalic AD in this study. We compared their clinical and imaging findings with those of 123 typical AD without hydrocephalic signs/symptoms. We also investigated the frequency and potential predictors of the tap test response in hydrocephalic AD. RESULTS Evans' index was 0.36±0.03, and a disproportionately enlarged subarachnoid space was present in 54.2% of the hydrocephalic AD patients. The mean age (75.2±7.3 years) and the APOE4 frequency (68.2%) did not differ from those of AD controls. However, the hydrocephalic AD patients showed better memory and language performance, and a thinner cingulate cortex. About 42% of the hydrocephalic AD patients responded to the tap test, of whom seven underwent shunt surgery. Cognition did not improve, whereas gait improved after shunt surgery in all. CONCLUSION Hydrocephalic AD has different neuropsychological and imaging characteristics from typical AD. Future studies are warranted to further investigate the effect of CSF removal on their clinical course and to elucidate the pathophysiological interaction between amyloid and NPH.
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Affiliation(s)
- Hyemin Jang
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu-Hyun Park
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sim Choe
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hoon Kang
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sook Kang
- Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seunghoon Lee
- Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea.,Samsung Alzheimer Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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17
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Soon SXY, Kumar AA, Tan AJL, Lo YT, Lock C, Kumar S, Kwok J, Keong NC. The Impact of Multimorbidity Burden, Frailty Risk Scoring, and 3-Directional Morphological Indices vs. Testing for CSF Responsiveness in Normal Pressure Hydrocephalus. Front Neurosci 2021; 15:751145. [PMID: 34867163 PMCID: PMC8636813 DOI: 10.3389/fnins.2021.751145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: Multimorbidity burden across disease cohorts and variations in clinico-radiographic presentations within normal pressure hydrocephalus (NPH) confound its diagnosis, and the assessment of its amenability to interventions. We hypothesized that novel imaging techniques such as 3-directional linear morphological indices could help in distinguishing between hydrocephalus vs. non-hydrocephalus and correlate with responsiveness to external lumbar drainage (CSF responsiveness) within NPH subtypes. Methodology: Twenty-one participants with NPH were recruited and age-matched to 21 patients with Alzheimer’s Disease (AD) and 21 healthy controls (HC) selected from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Patients with NPH underwent testing via the NPH programme with external lumbar drainage (ELD); pre- and post-ELD MRI scans were obtained. The modified Frailty Index (mFI-11) was used to stratify the NPH cohort, including Classic and Complex subtypes, by their comorbidity and frailty risks. The quantitative imaging network tool 3D Slicer was used to derive traditional 2-dimensional (2d) linear measures; Evans Index (EI), Bicaudate Index (BCI) and Callosal Angle (CA), along with novel 3-directional (3d) linear measures; z-Evans Index and Brain per Ventricle Ratio (BVR). 3-Dimensional (3D) ventricular volumetry was performed as an independent correlate of ventriculomegaly to CSF responsiveness. Results: Mean age for study participants was 71.14 ± 6.3 years (18, 85.7% males). The majority (15/21, 71.4%) of participants with NPH comprised the Complex subtype (overlay from vascular risk burden and AD); 12/21 (57.1%) were Non-Responders to ELD. Frailty alone was insufficient in distinguishing between NPH subtypes. By contrast, 3d linear measures distinguished NPH from both AD and HC cohorts, but also correlated to CSF responsiveness. The z-Evans Index was the most sensitive volumetric measure of CSF responsiveness (p = 0.012). Changes in 3d morphological indices across timepoints distinguished between Responders vs. Non-Responders to lumbar testing. There was a significant reduction of indices, only in Non-Responders and across multiple measures (z-Evans Index; p = 0.001, BVR at PC; p = 0.024). This was due to a significant decrease in ventricular measurement (p = 0.005) that correlated to independent 3D volumetry (p = 0.008). Conclusion. In the context of multimorbidity burden, frailty risks and overlay from neurodegenerative disease, 3d morphological indices demonstrated utility in distinguishing hydrocephalus vs. non-hydrocephalus and degree of CSF responsiveness. Further work may support the characterization of patients with Complex NPH who would best benefit from the risks of interventions.
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Affiliation(s)
- Shereen X Y Soon
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - A Aravin Kumar
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Audrey J L Tan
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Christine Lock
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Sumeet Kumar
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
| | - Janell Kwok
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Nicole C Keong
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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18
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Blinkouskaya Y, Caçoilo A, Gollamudi T, Jalalian S, Weickenmeier J. Brain aging mechanisms with mechanical manifestations. Mech Ageing Dev 2021; 200:111575. [PMID: 34600936 PMCID: PMC8627478 DOI: 10.1016/j.mad.2021.111575] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/09/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022]
Abstract
Brain aging is a complex process that affects everything from the subcellular to the organ level, begins early in life, and accelerates with age. Morphologically, brain aging is primarily characterized by brain volume loss, cortical thinning, white matter degradation, loss of gyrification, and ventricular enlargement. Pathophysiologically, brain aging is associated with neuron cell shrinking, dendritic degeneration, demyelination, small vessel disease, metabolic slowing, microglial activation, and the formation of white matter lesions. In recent years, the mechanics community has demonstrated increasing interest in modeling the brain's (bio)mechanical behavior and uses constitutive modeling to predict shape changes of anatomically accurate finite element brain models in health and disease. Here, we pursue two objectives. First, we review existing imaging-based data on white and gray matter atrophy rates and organ-level aging patterns. This data is required to calibrate and validate constitutive brain models. Second, we review the most critical cell- and tissue-level aging mechanisms that drive white and gray matter changes. We focuse on aging mechanisms that ultimately manifest as organ-level shape changes based on the idea that the integration of imaging and mechanical modeling may help identify the tipping point when normal aging ends and pathological neurodegeneration begins.
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Affiliation(s)
- Yana Blinkouskaya
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States
| | - Andreia Caçoilo
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States
| | - Trisha Gollamudi
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States
| | - Shima Jalalian
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States
| | - Johannes Weickenmeier
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States.
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19
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Kim M, Park SW, Lee JY, Kim H, Rhim JH, Park S, Lee JY, Son H, Kim YK, Lee SH. Differences in Brain Morphology between Hydrocephalus Ex Vacuo and Idiopathic Normal Pressure Hydrocephalus. Psychiatry Investig 2021; 18:628-635. [PMID: 34265199 PMCID: PMC8328827 DOI: 10.30773/pi.2020.0352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/10/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The distinction between idiopathic normal pressure hydrocephalus (iNPH) and hydrocephalus ex vacuo caused by encephalic volume loss remains to be established. This study aims to investigate radiological parameters as clinically useful tools to discriminate iNPH from hydrocephalus ex vacuo caused by Alzheimer's disease (AD). METHODS A total of 54 patients with ventriculomegaly (iNPH, 25; hydrocephalus ex vacuo, 29) were recruited in this study. Consequently, nine radiological parameters were compared between iNPH and hydrocephalus ex vacuo using magnetic resonance imaging (MRI). RESULTS A small callosal angle (CA), the Sylvian fissure dilatation, and absence of narrowing of superior parietal sulci discriminated the iNPH group from the hydrocephalus ex vacuo group (p<0.05). The final binary logistic regression model included narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure after controlling for age and global Clinical Dementia Rating (CDR). The composite score made from these three indicators (narrowing of superior parietal sulci, degrees of the CA, and height of the Sylvian fissure) was statistically different between iNPH and hydrocephalus ex vacuo. CONCLUSION The narrowing of the CA, dilatation of the Sylvain fissure, and narrowing of superior parietal sulci may be used as radiological key indices and noninvasive tools for the differential diagnosis of iNPH from hydrocephalus ex vacuo.
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Affiliation(s)
- Minkyung Kim
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Won Park
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Hongrae Kim
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jung Hyo Rhim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Soowon Park
- Department of Teacher Education, College of Liberal Arts and Interdisciplinary Studies, Kyonggi University, Suwon, Republic of Korea
| | - Jee-Young Lee
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sang Hyung Lee
- Department of Neurosurgery, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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20
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Ryska P, Slezak O, Eklund A, Salzer J, Malm J, Zizka J. Variability of Normal Pressure Hydrocephalus Imaging Biomarkers with Respect to Section Plane Angulation: How Wrong a Radiologist Can Be? AJNR Am J Neuroradiol 2021; 42:1201-1207. [PMID: 33888457 DOI: 10.3174/ajnr.a7095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/13/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Systematic analysis of angulation-related variability of idiopathic normal pressure hydrocephalus imaging biomarkers has not been published yet. Our aim was to evaluate the variability of these radiologic biomarkers with respect to imaging plane angulation. MATERIALS AND METHODS Eighty subjects (35 with clinically confirmed idiopathic normal pressure hydrocephalus and 45 age- and sex-matched healthy controls) were prospectively enrolled in a 3T brain MR imaging study. Two independent readers assessed 12 radiologic idiopathic normal pressure hydrocephalus biomarkers on sections aligned parallel or perpendicular to the bicallosal, bicommissural, hypophysis-fastigium, and brain stem vertical lines, respectively. RESULTS Disproportionately enlarged subarachnoid space hydrocephalus, simplified callosal angle, frontal horn diameter, z-Evans Index, and cella media vertical width did not show significant systematic differences in any of 6 section plane combinations studied. The remaining 7 biomarkers (including the Evans Index and callosal angle) showed significant differences in up to 4 of 6 mutually compared section plane combinations. The values obtained from sections aligned with the brain stem vertical line (parallel to the posterior brain stem margin) showed the most deviating results from other section angulations. CONCLUSIONS Seven of 12 idiopathic normal pressure hydrocephalus biomarkers including the frequently used Evans Index and callosal angle showed statistically significant deviations when measured on sections whose angulations differed or did not comply with the proper section definition published in the original literature. Strict adherence to the methodology of idiopathic normal pressure hydrocephalus biomarker assessment is, therefore, essential to avoid an incorrect diagnosis. Increased radiologic and clinical attention should be paid to the biomarkers showing low angulation-related variability yet high specificity for idiopathic normal pressure hydrocephalus-related morphologic changes such as the z-Evans Index, frontal horn diameter, or disproportionately enlarged subarachnoid space hydrocephalus.
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Affiliation(s)
- P Ryska
- From the Department of Diagnostic Radiology (P.R., O.S.), University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - O Slezak
- From the Department of Diagnostic Radiology (P.R., O.S.), University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Department of Diagnostic Radiology (O.S.), Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - A Eklund
- Departments of Radiation Sciences (A.E.)
| | - J Salzer
- Pharmacology and Clinical Neuroscience (J.S., J.M.), Section of Neurology
| | - J Malm
- Pharmacology and Clinical Neuroscience (J.S., J.M.), Section of Neurology
| | - J Zizka
- Imaging and Functional Medicine (J.Z.), University Hospital of Umeå, Umeå, Sweden
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21
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Han SW, Park YH, Ryoo N, Kim K, Pyun JM, Kim S. Pearls & Oy-sters: Idiopathic Normal Pressure Hydrocephalus With Synucleinopathy: Diagnosis and Treatment. Neurology 2021; 97:196-199. [PMID: 33931530 DOI: 10.1212/wnl.0000000000012099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sang-Won Han
- From the Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Republic of Korea
| | - Young Ho Park
- From the Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Republic of Korea.
| | - Nayoung Ryoo
- From the Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Republic of Korea
| | - Kitae Kim
- From the Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Republic of Korea
| | - Jung-Min Pyun
- From the Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Republic of Korea
| | - SangYun Kim
- From the Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Republic of Korea
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22
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Won YD, Kim JM, Cheong JH, Ryu JI, Yi HJ, Han MH. Effect of Osteoporotic Condition on Ventriculomegaly and Shunt-Dependent Hydrocephalus After Subarachnoid Hemorrhage. Stroke 2021; 52:994-1003. [PMID: 33535781 DOI: 10.1161/strokeaha.120.031044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hydrocephalus is a common complication in aneurysmal rupture subarachnoid hemorrhage (SAH). As both the bone and arachnoid trabeculae are composed of type 1 collagen, we identified the possible relationship between bone mineral density and ventriculomegaly and shunt-dependent hydrocephalus (SDHC) development after aneurysmal rupture SAH in younger patients. METHODS We measured frontal skull Hounsfield unit (HU) values on brain computed tomography upon admission, and mean frontal skull HU values were used instead of T-score value. Hazard ratios were calculated using Cox regression analysis to identify whether osteoporotic condition is an independent predictor for ventriculomegaly and SDHC after surgical clipping for SAH in younger patients. RESULTS Altogether, 412 patients (≤65 years) who underwent surgical clipping for primary spontaneous SAH from a ruptured aneurysm were enrolled in this 11-year analysis in 2 hospitals. We observed that the first tertile group of skull HU was an independent predictor of SDHC after SAH compared with the third tertile of skull HU values (hazard ratio, 2.55 [95% CI, 1.25-5.20]; P=0.010). There were no significant interactions between age and skull HU with respect to ventriculomegaly and SDHC in younger patients. CONCLUSIONS Our study suggests a relationship between possible osteoporotic conditions and ventriculomegaly and SDHC development after SAH in younger patients. Our findings may be useful in predicting hydrocephalus in young SAH patients using a convenient method of measuring skull HU value on brain computed tomography upon admission.
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Affiliation(s)
- Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea (H.-J.Y.)
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyonggi-do, Korea (Y.D.W., J.M.K., J.H.C., J.I.R., M.-H.H.)
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23
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Maragkos GA, Filippidis AS, Chilamkurthy S, Salem MM, Tanamala S, Gomez-Paz S, Rao P, Moore JM, Papavassiliou E, Hackney D, Thomas AJ. Automated Lateral Ventricular and Cranial Vault Volume Measurements in 13,851 Patients Using Deep Learning Algorithms. World Neurosurg 2021; 148:e363-e373. [PMID: 33421645 DOI: 10.1016/j.wneu.2020.12.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND No large dataset-derived standard has been established for normal or pathologic human cerebral ventricular and cranial vault volumes. Automated volumetric measurements could be used to assist in diagnosis and follow-up of hydrocephalus or craniofacial syndromes. In this work, we use deep learning algorithms to measure ventricular and cranial vault volumes in a large dataset of head computed tomography (CT) scans. METHODS A cross-sectional dataset comprising 13,851 CT scans was used to deploy U-Net deep learning networks to segment and quantify lateral cerebral ventricular and cranial vault volumes in relation to age and sex. The models were validated against manual segmentations. Corresponding radiologic reports were annotated using a rule-based natural language processing framework to identify normal scans, cerebral atrophy, or hydrocephalus. RESULTS U-Net models had high fidelity to manual segmentations for lateral ventricular and cranial vault volume measurements (Dice index, 0.878 and 0.983, respectively). The natural language processing identified 6239 (44.7%) normal radiologic reports, 1827 (13.1%) with cerebral atrophy, and 1185 (8.5%) with hydrocephalus. Age-based and sex-based reference tables with medians, 25th and 75th percentiles for scans classified as normal, atrophy, and hydrocephalus were constructed. The median lateral ventricular volume in normal scans was significantly smaller compared with hydrocephalus (15.7 vs. 82.0 mL; P < 0.001). CONCLUSIONS This is the first study to measure lateral ventricular and cranial vault volumes in a large dataset, made possible with artificial intelligence. We provide a robust method to establish normal values for these volumes and a tool to report these on CT scans when evaluating for hydrocephalus.
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Affiliation(s)
- Georgios A Maragkos
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Aristotelis S Filippidis
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mohamed M Salem
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Santiago Gomez-Paz
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Justin M Moore
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Efstathios Papavassiliou
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Hackney
- Radiology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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24
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Liu M, Zhang J, Zong L, Fan W, Wang B, Chen Z. The Differential Diagnostic Value of the Callosal Angle and Evans Index in Mild Cognitive Impairment and Alzheimer's Disease. Curr Med Imaging 2020; 17:889-896. [PMID: 33357199 PMCID: PMC8811612 DOI: 10.2174/1573405616666201223150004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/06/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
Background Callosal Angle (CA) and Evans Index (EI) are considered as imaging biomarkers to diagnose normal-pressure hydrocephalus using traditional MR measurement methods. Objective The current study aimed to evaluate the differential diagnostic value of CA and EI in Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD). Methods Five-hundred and two subjects were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database, which included 168 Normal Controls (NC), 233 MCI and 101 AD patients. The structural MR images were interactively applied with multiplanar reconstruction to measure the CA and EI. Results CA presented no significant difference among NC, MCI and AD groups (H value = 3.848, P value = 0.146), and EI demonstrated higher value in MCI and AD groups than that in NC groups (P = 0.000 and 0.001, respectively). MCI group had significant larger EI (0.29±0.04) than (0.27±0.03) NC group in 70-75 years old sub-groups. ROC showed that the area under the curve was 0.704±0.045 for NC-MCI in 70-75 years old groups. The correlation analysis indicated that EI was significantly negatively related to MMSE scores of MCI patients (r = -0.131, P = 0.046). Conclusion EI might serve as a screening imaging biomarker for MCI in 70-75 years old patients, and show limited differential value for the diagnosis of AD. CA could present no diagnostic value for MCI and AD in the current study.
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Affiliation(s)
- Mengqi Liu
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jing Zhang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Linxiong Zong
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Wenping Fan
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Botao Wang
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Zhiye Chen
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
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25
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Zhou X, Ye Q, Jiang Y, Wang M, Niu Z, Menpes-Smith W, Fang EF, Liu Z, Xia J, Yang G. Systematic and Comprehensive Automated Ventricle Segmentation on Ventricle Images of the Elderly Patients: A Retrospective Study. Front Aging Neurosci 2020; 12:618538. [PMID: 33390930 PMCID: PMC7772233 DOI: 10.3389/fnagi.2020.618538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Ventricle volume is closely related to hydrocephalus, brain atrophy, Alzheimer's, Parkinson's syndrome, and other diseases. To accurately measure the volume of the ventricles for elderly patients, we use deep learning to establish a systematic and comprehensive automated ventricle segmentation framework. Methods: The study participation included 20 normal elderly people, 20 patients with cerebral atrophy, 64 patients with normal pressure hydrocephalus, and 51 patients with acquired hydrocephalus. Second, get their imaging data through the picture archiving and communication systems (PACS) system. Then use ITK software to manually label participants' ventricular structures. Finally, extract imaging features through machine learning. Results: This automated ventricle segmentation method can be applied not only to CT and MRI images but also to images with different scan slice thicknesses. More importantly, it produces excellent segmentation results (Dice > 0.9). Conclusion: This automated ventricle segmentation method has wide applicability and clinical practicability. It can help clinicians find early disease, diagnose disease, understand the patient's disease progression, and evaluate the patient's treatment effect.
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Affiliation(s)
- Xi Zhou
- Department of Radiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qinghao Ye
- Hangzhou Ocean's Smart Boya Co., Ltd., Hangzhou, China.,Mind Rank Ltd., Hongkong, China
| | - Yinghui Jiang
- Hangzhou Ocean's Smart Boya Co., Ltd., Hangzhou, China.,Mind Rank Ltd., Hongkong, China
| | - Minhao Wang
- Hangzhou Ocean's Smart Boya Co., Ltd., Hangzhou, China.,Mind Rank Ltd., Hongkong, China
| | - Zhangming Niu
- Aladdin Healthcare Technologies Ltd., London, United Kingdom
| | | | - Evandro Fei Fang
- Department of Clinical Molecular Biology, University of Oslo, Oslo, Norway
| | - Zhi Liu
- School of Information Science and Engineering, Shandong University, Qingdao, China
| | - Jun Xia
- Department of Radiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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26
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Hamed MA, Ponce FA, Lambert M, Moguel-Cobos G. Subcortical Atrophy and Motor Outcomes in Pallidal Deep Brain Stimulation for Parkinson Disease. World Neurosurg 2020; 142:e89-e94. [PMID: 32540287 DOI: 10.1016/j.wneu.2020.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Appropriate patient selection is critical for successful deep brain stimulation (DBS) for Parkinson disease (PD). Subcortical atrophy is a possible determinant of postoperative DBS outcomes in patients with idiopathic PD, but it has not been well evaluated for DBS of the globus pallidus interna (GPi). We investigated perioperative subcortical atrophy measures in patients with PD and their relationship to postoperative motor response in bilateral GPi-targeted DBS. METHODS A retrospective cohort study examined correlations among indices of subcortical volumetry, disease duration, and age with postoperative outcomes at 6 months (Unified Parkinson's Disease Rating Scale Part III motor score quotient, levodopa equivalent daily dosing, and 39-item Parkinson's Disease Questionnaire mobility subscore). Subcortical volumetry was assessed by bicaudate ratio, Evans index, and third ventricular width on perioperative imaging. Linear regression models established correlations between preoperative variables and postoperative outcomes. RESULTS Data from 34 patients with PD who were treated with GPi-targeted DBS were evaluated. Age was found to exhibit statistically significant positive correlations with all 3 measures of subcortical atrophy (P ≤ 0.002). None of the measures correlated with disease duration. Only Evans index and third ventricular width correlated with preoperative medication response (P < 0.05). Age and all 3 measures of atrophy exhibited statistically significant correlations with Unified Parkinson's Disease Rating Scale Part III motor score quotient (P ≤ 0.01), but not with levodopa equivalent daily dosing or 39-item Parkinson's Disease Questionnaire motor subscores (P > 0.05). CONCLUSIONS Perioperative age and subcortical atrophy as measured in this study correlated with motor responsiveness at 6 months postoperatively among patients receiving bilateral GPi-targeted DBS stimulation for PD.
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Affiliation(s)
- Moath A Hamed
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Margaret Lambert
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Guillermo Moguel-Cobos
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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27
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Gutowski P, Rot S, Fritsch M, Meier U, Gölz L, Lemcke J. Secondary deterioration in patients with normal pressure hydrocephalus after ventriculoperitoneal shunt placement: a proposed algorithm of treatment. Fluids Barriers CNS 2020; 17:18. [PMID: 32127017 PMCID: PMC7055114 DOI: 10.1186/s12987-020-00180-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background After ventriculoperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (iNPH) with adjustable gravitational valves, a certain proportion of patients develop secondary clinical worsening after initial improvement of clinical symptoms. The aim of this study was to analyze this group of patients with secondary deterioration and to evaluate the performed shunt management. Methods For this investigation, we retrospectively reviewed our NPH registry for patients included between 1999 and 2013 with a decrease by a minimum of two points in the Kiefer score in the first year of follow up and an increase of two points in the Kiefer score between the second and the fifth year after shunt surgery (secondary deterioration). Then, we analyzed the patient’s shunt management (adapting the valve pressure setting, shuntography, valve replacement, catheter replacement, implant an adjustable gravitational unit). Additionally, we searched for risk factors for secondary deterioration. Results Out of 259 iNPH patients, 53 (20%) patients showed secondary deterioration on an average of 2.7 (2–4 years) years after shunt surgery. Fourteen (26%) patients with secondary deterioration improved after shunt or valve management and 58% remained without clinical benefit after management. We had a drop-out rate of 15% due to incomplete datasets. Our shunt management reduced the rate of secondary deterioration from 20 to 15%. On the basis of our findings, we developed an algorithm for shunt management. Risk factors for secondary deterioration are the age of the patient at the time of shunting, newly diagnosed neurodegenerative diseases, and overdrainage requiring adjusting the valve to higher-pressure levels. Conclusion Twenty percent of patients with iNPH were at risk for secondary clinical worsening about 3 years after shunt surgery. About one-fourth of these patients benefited for additional years from pressure level management and/or shunt valve revision. Our findings underline the need for long-term follow-ups and intensive shunt management to achieve a favorable long-term outcome for patients with iNPH and VPS.
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Affiliation(s)
- Pawel Gutowski
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Germany.
| | - Sergej Rot
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Germany
| | - Michael Fritsch
- Department of Neurosurgery, Dietrich Bonhoeffer Klinikum, Neubrandenburg, Germany
| | - Ullrich Meier
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Germany
| | - Leonie Gölz
- Department of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Johannes Lemcke
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Germany
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28
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Sparks P, Lawrence T, Hinze S. Neuroimaging in the Diagnosis of Chronic Traumatic Encephalopathy: A Systematic Review. Clin J Sport Med 2020; 30 Suppl 1:S1-S10. [PMID: 32132472 DOI: 10.1097/jsm.0000000000000541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repeated subconcussive and concussive head injury. Clinical features include cognitive, behavioral, mood, and motor impairments. Definitive diagnosis is only possible at postmortem. Here, the utility of neuroimaging in the diagnosis of CTE is evaluated by systematically reviewing recent evidence for changes in neuroimaging biomarkers in suspected cases of CTE compared with controls. DATA SOURCES Providing an update on a previous systematic review of articles published until December 2014, we searched for articles published between December 2014 and July 2016. We searched PubMed for studies assessing neuroimaging changes in symptomatic suspected cases of CTE with a history of repeated subconcussive or concussive head injury or participation in contact sports involving direct impact to the head. Exclusion criteria were case studies, review articles, and articles focusing on repetitive head trauma from military service, head banging, epilepsy, physical abuse, or animal models. MAIN RESULTS Seven articles met the review criteria, almost all of which studied professional athletes. The range of modalities were categorized into structural magnetic resonance imaging (MRI), diffusion MRI, and radionuclide studies. Biomarkers which differed significantly between suspected CTE and controls were Evans index (P = 0.05), cavum septum pellucidum (CSP) rate (P < 0.0006), length (P < 0.03) and ratio of CSP length to septum length (P < 0.03), regional differences in axial diffusivity (P < 0.05) and free/intracellular water fractions (P < 0.005), single-photon emission computed tomography perfusion abnormalities (P < 0.01), positron emission tomography (PET) signals from tau-binding, glucose-binding, and GABA receptor-binding radionuclides (P < 0.0001, P < 0.005, and P < 0.005, respectively). Important limitations include low specificity in identification of suspected cases of CTE across studies, the need for postmortem validation, and a lack of generalizability to nonprofessional athletes. CONCLUSIONS The most promising biomarker is tau-binding radionuclide PET signal because it is most specific to the underlying neuropathology and differentiated CTE from both controls and patients with Alzheimer disease (P < 0.0001). Multimodal imaging will improve specificity further. Future research should minimize variability in identification of suspected cases of CTE using published clinical criteria.
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Ryska P, Slezak O, Eklund A, Malm J, Salzer J, Zizka J. Radiological markers of idiopathic normal pressure hydrocephalus: Relative comparison of their diagnostic performance. J Neurol Sci 2020; 408:116581. [DOI: 10.1016/j.jns.2019.116581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/17/2019] [Accepted: 11/15/2019] [Indexed: 02/01/2023]
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Longitudinal morphological changes during recovery from brain deformation due to idiopathic normal pressure hydrocephalus after ventriculoperitoneal shunt surgery. Sci Rep 2019; 9:17318. [PMID: 31754171 PMCID: PMC6872815 DOI: 10.1038/s41598-019-53888-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 11/07/2019] [Indexed: 01/24/2023] Open
Abstract
The present study aimed to examine time-dependent change in cerebrospinal fluid distribution and various radiological indices for evaluating shunt effectiveness in patients with idiopathic normal pressure hydrocephalus (iNPH). This study included 54 patients with iNPH who underwent MRI before and after ventriculoperitoneal shunt surgery. The volume of the total ventricles and subarachnoid spaces decreased within 1 month after shunting. However, more than 1 year after shunting, the volume of the total ventricles decreased, whereas that of the total subarachnoid spaces increased. Although cerebrospinal fluid distribution changed considerably throughout the follow-up period, the brain parenchyma expanded only 2% from the baseline brain volume within 1 month after shunting and remained unchanged thereafter. The volume of the convexity subarachnoid space markedly increased. The changing rate of convexity subarachnoid space per ventricle ratio (CVR) was greater than that of any two-dimensional index. The brain per ventricle ratio (BVR), callosal angle and z-Evans index continued gradually changing, whereas Evans index did not change throughout the follow-up period. Both decreased ventricular volume and increased convexity subarachnoid space volume were important for evaluating shunt effectiveness. Therefore, we recommend CVR and BVR as useful indices for the diagnosis and evaluation of treatment response in patients with iNPH.
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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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Dallmeier JD, Meysami S, Merrill DA, Raji CA. Emerging advances of in vivo detection of chronic traumatic encephalopathy and traumatic brain injury. Br J Radiol 2019; 92:20180925. [PMID: 31287716 DOI: 10.1259/bjr.20180925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder that is of epidemic proportions in contact sports athletes and is linked to subconcussive and concussive repetitive head impacts (RHI). Although postmortem analysis is currently the only confirmatory method to diagnose CTE, there has been progress in early detection techniques of fluid biomarkers as well as in advanced neuroimaging techniques. Specifically, promising new methods of diffusion MRI and radionucleotide PET scans could aid in the early detection of CTE.The authors examine early detection methods focusing on various neuroimaging techniques. Advances in structural and diffusion MRI have demonstrated the ability to measure volumetric and white matter abnormalities associated with CTE. Recent studies using radionucleotides such as flortaucipir and 18F-FDDNP have shown binding patterns that are consistent with the four stages of neurofibrillary tangle (NFT) distribution postmortem. Additional research undertakings focusing on fMRI, MR spectroscopy, susceptibility-weighted imaging, and singlephoton emission CT are also discussed as are advanced MRI methods such as diffusiontensor imaging and arterial spin labeled. Neuroimaging is fast becoming a key instrument in early detection and could prove essential for CTE quantification. This review explores a global approach to in vivo early detection.Limited data of in vivo CTE biomarkers with postmortem confirmation are available. While some data exist, they are limited by selection bias. It is unlikely that a single test will be sufficient to properly diagnosis and distinguish CTE from other neurodegenerative diseases such as Alzheimer disease or Frontotemporal Dementia. However, with a combination of fluid biomarkers, neuroimaging, and genetic testing, early detection may become possible.
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Affiliation(s)
- Julian D Dallmeier
- 1Department of Neuroscience, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Somayeh Meysami
- 2Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David A Merrill
- 3Psychiatry and Biobehavioral Sciences and Pacific Brain Health Center, UCLA and Pacific Neuroscience Institute, Los Angeles, California, United States
| | - Cyrus A Raji
- 4Radiology, Washington University Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
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Schirmer MD, Giese AK, Fotiadis P, Etherton MR, Cloonan L, Viswanathan A, Greenberg SM, Wu O, Rost NS. Spatial Signature of White Matter Hyperintensities in Stroke Patients. Front Neurol 2019; 10:208. [PMID: 30941083 PMCID: PMC6433778 DOI: 10.3389/fneur.2019.00208] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/18/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: White matter hyperintensity (WMH) is a common phenotype across a variety of neurological diseases, particularly prevalent in stroke patients; however, vascular territory dependent variation in WMH burden has not yet been identified. Here, we sought to investigate the spatial specificity of WMH burden in patients with acute ischemic stroke (AIS). Materials and Methods: We created a novel age-appropriate high-resolution brain template and anatomically delineated the cerebral vascular territories. We used WMH masks derived from the clinical T2 Fluid Attenuated Inverse Recovery (FLAIR) MRI scans and spatial normalization of the template to discriminate between WMH volume within each subject's anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) territories. Linear regression modeling including age, sex, common vascular risk factors, and TOAST stroke subtypes was used to assess for spatial specificity of WMH volume (WMHv) in a cohort of 882 AIS patients. Results: Mean age of this cohort was 65.23 ± 14.79 years, 61.7% were male, 63.6% were hypertensive, 35.8% never smoked. Mean WMHv was 11.58c ± 13.49 cc. There were significant differences in territory-specific, relative to global, WMH burden. In contrast to PCA territory, age (0.018 ± 0.002, p < 0.001) and small-vessel stroke subtype (0.212 ± 0.098, p < 0.001) were associated with relative increase of WMH burden within the anterior (ACA and MCA) territories, whereas male sex (-0.275 ± 0.067, p < 0.001) was associated with a relative decrease in WMHv. Conclusions: Our data establish the spatial specificity of WMH distribution in relation to vascular territory and risk factor exposure in AIS patients and offer new insights into the underlying pathology.
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Affiliation(s)
- Markus D. Schirmer
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Computer Science and Artificial Intelligence Lab, MIT, Cambridge, MA, United States
- Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Anne-Katrin Giese
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Panagiotis Fotiadis
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mark R. Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lisa Cloonan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Steven M. Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ona Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
| | - Natalia S. Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Kariev GM, Asadullaev UM, Duschanov TA, Rasulov SO, Mamadaliev DMV, Khodjimetov DN. The Importance of Measuring Mamillopontine Distance as a Diagnostic Criterion of Hydrocephalus Degrees. Asian J Neurosurg 2019; 14:166-171. [PMID: 30937029 PMCID: PMC6417336 DOI: 10.4103/ajns.ajns_79_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The occurrence of obstructive hydrocephalus (ObH) as sequelae of deep midline brain tumors (third and lateral ventricles, thalamic, pineal region, brainstem, and fourth ventricle) can be estimated up to 90% of cases. We believe that the mamillopontine distance (MPD) - the distance between the lower surface of the mammillary body and the upper surface of the pons in the sagittal images - can be a sufficiently reliable alternative to the Evans' index (EI) for the diagnosis of ObH. PATIENTS AND METHODS The results of mamillopontine distance (MPD), Evans' index (EI), and angle of corpus callosum (ACC) measurement of 43 patients with non-communicative hydrocephalus were analyzed compared with results of 30 people without brain pathology. RESULTS Findings revealed that MPD is a strong and reliable alternative to the EI. MPD showed high specificity and sensitivity in the diagnosis of occlusive hydrocephalus. Moreover, from those findings, we have proposed classification of the degree of hydrocephalus severity, depending on the MPD. CONCLUSION MPD one of the more accurate and powerful method for defining presence of hydrocephalus in-patient even in early stage of occlusion. It has high specificity and sensitivity and capable classify hydrocephalus into grades according to severity.
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Affiliation(s)
- Gayrat Maratovich Kariev
- Republican Specialized Scientific and Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan
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Evaluation index for asymmetric ventricular size on brain magnetic resonance images in very low birth weight infants. Brain Dev 2018; 40:753-759. [PMID: 29807844 DOI: 10.1016/j.braindev.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/22/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Asymmetric ventriculomegaly is often evident on brain magnetic resonance imaging (MRI) in very low birth weight infants (VLBWI) and is interpreted as white matter injury. However, no evaluation index for asymmetric left-right and anterior-posterior ventricular sizes has been established. METHODS In this retrospective multicenter cohort study, brain T2-weighted MRI was performed at term-equivalent ages in 294 VLBWI born between 2009 and 2011. The value of a lateral ventricular index (LVI) to evaluate asymmetric ventricular size, as well as the relationship between the LVI value and walking at a corrected age of 18 months was investigated. At the level of the foramen of Monro in a horizontal slice, asymmetry between the left and right sides and between the anterior and posterior horns was identified by the corrected width and was detected by a low concordance rate and κ statistic value. An LVI representing the sum of the widths of the four horns of the lateral ventricle corrected for cerebral diameter was devised. RESULTS Asymmetric left-right and anterior-posterior ventricular sizes were confirmed. The LVI value was significantly higher in the non-walking VLBWI group (n = 39) than in the walking VLBWI group (n = 255; 18.2 vs. 15.8, p = 0.02). An LVI cut-off value of 21.5 was associated with non-walking. Multivariate analysis revealed that an LVI value >21.5 was an independent predictor of walking disability at the corrected age of 18 months (odds ratio 2.56, p = 0.008). CONCLUSIONS The LVI value calculated via MRI may predict walking disability at a corrected age of 18 months in VLBWI.
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Kang K, Kwak K, Yoon U, Lee JM. Lateral Ventricle Enlargement and Cortical Thinning in Idiopathic Normal-pressure Hydrocephalus Patients. Sci Rep 2018; 8:13306. [PMID: 30190599 PMCID: PMC6127145 DOI: 10.1038/s41598-018-31399-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/14/2018] [Indexed: 01/26/2023] Open
Abstract
We utilized three-dimensional, surface-based, morphometric analysis to investigate ventricle shape between 2 groups: (1) idiopathic normal-pressure hydrocephalus (INPH) patients who had a positive response to the cerebrospinal fluid tap test (CSFTT) and (2) healthy controls. The aims were (1) to evaluate the location of INPH-related structural abnormalities of the lateral ventricles and (2) to investigate relationships between lateral ventricular enlargement and cortical thinning in INPH patients. Thirty-three INPH patients and 23 healthy controls were included in this study. We used sparse canonical correlation analysis to show correlated regions of ventricular surface expansion and cortical thinning. Significant surface expansion in the INPH group was observed mainly in clusters bilaterally located in the superior portion of the lateral ventricles, adjacent to the high convexity of the frontal and parietal regions. INPH patients showed a significant bilateral expansion of both the temporal horns of the lateral ventricles and the medial aspects of the frontal horns of the lateral ventricles to surrounding brain regions, including the medial frontal lobe. Ventricular surface expansion was associated with cortical thinning in the bilateral orbitofrontal cortex, bilateral rostral anterior cingulate cortex, left parahippocampal cortex, left temporal pole, right insula, right inferior temporal cortex, and right fusiform gyrus. These results suggest that patients with INPH have unique patterns of ventricular surface expansion. Our findings encourage future studies to elucidate the underlying mechanism of lateral ventricular morphometric abnormalities in INPH patients.
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Affiliation(s)
- Kyunghun Kang
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.,Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kichang Kwak
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Uicheul Yoon
- Department of Biomedical Engineering, Daegu Catholic University, Gyeongsan-si, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.
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Frizon LA, Hogue O, Achey R, Floden DP, Nagel S, Machado AG, Lobel DA. Quality of Life Improvement Following Deep Brain Stimulation for Parkinson Disease: Development of a Prognostic Model. Neurosurgery 2018; 85:343-349. [DOI: 10.1093/neuros/nyy287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/02/2018] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
There is a growing attention to determine the factors that predict quality of life (QoL) improvement after deep brain stimulation (DBS) for Parkinson's disease. Prior literature has largely focused on examining predictors one at a time, sometimes controlling for covariates.
OBJECTIVE
To develop a model that could be used as a nomogram to predict improvement in QoL following DBS surgery in patients with Parkinson's disease.
METHODS
All patients with complete pre- and postoperative movement disorder and neuropsychological testing who underwent DBS at a single institution between 2007-2012 were analyzed. The Parkinson's Disease Questionnaire-39 (PDQ-39) was used to measure QoL. Potential predictive factors, including patient demographics, clinical presentation characteristics, radiographic imaging, and motor and psychological testing were analyzed for impact on QoL.
RESULTS
Sixty-seven patients were identified, 36 (53.73%) of whom had meaningfully improved QoL following surgery. Five baseline variables showed significant relationships with the outcome: years since symptom onset, percent change in on/off motor evaluation, levodopa equivalent daily dose, bilateral vs unilateral DBS implantation, and PDQ-39 score. The final model includes PDQ-39, percent change in UPRS-III, and years since symptom onset and is able to predict improvement in QoL with 81% accuracy.
CONCLUSION
Our model accurately predicted whether QoL would improve in patients undergoing subthalamic nucleus DBS 81% of the time. Our data may serve as the foundation to further refine a clinically relevant prognostic tool that would assist the decision-making process for clinicians and DBS multidisciplinary teams assessing patient candidacy for surgery.
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Affiliation(s)
- Leonardo A Frizon
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic. Cleveland, Ohio
- Post-graduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic. Cleveland, Ohio
| | - Rebecca Achey
- Cleveland Clinic Lerner College of Medicine. Cleveland, Ohio
| | - Darlene P Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic. Cleveland, Ohio
| | - Sean Nagel
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic. Cleveland, Ohio
| | - Andre G Machado
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic. Cleveland, Ohio
| | - Darlene A Lobel
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic. Cleveland, Ohio
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The frontal skull Hounsfield unit value can predict ventricular enlargement in patients with subarachnoid haemorrhage. Sci Rep 2018; 8:10178. [PMID: 29977066 PMCID: PMC6033863 DOI: 10.1038/s41598-018-28471-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/22/2018] [Indexed: 12/24/2022] Open
Abstract
Hydrocephalus is a common complication following subarachnoid haemorrhage (SAH) arising from spontaneous aneurysm rupture. The Hounsfield unit (HU) value from computed tomography scans may reflect bone mineral density, which correlates with body mass index, which in turn is related to post-SAH ventricle size changes. We herein investigated potential associations between frontal skull HU values and ventricle size changes after SAH. HU values from four different areas in the frontal bone were averaged to minimize measurement errors. The bicaudate index and Evans ratio were measured using both baseline and follow-up CT images. CT images with bicaudate index >0.2 and Evans ratio >0.3 simultaneously were defined as indicating ventriculomegaly. We included 232 consecutive patients with SAH due to primary spontaneous aneurysm rupture, who underwent clipping over almost a 9-year period at a single institution. The first tertile of frontal skull HU values in older patients (≥55 years) was an independent predictor of ventriculomegaly after SAH, as compared to the third tertile in younger patients (hazard ratio, 4.01; 95% confidence interval 1.21-13.30; p = 0.023). The lower frontal skull HU value independently predicted ventricular enlargement post-SAH, due to the potential weak integrity of subarachnoid trabecular structures in younger patients.
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Del Brutto OH, Mera RM, Gladstone D, Sarmiento-Bobadilla M, Cagino K, Zambrano M, Costa AF, Sedler MJ. Inverse relationship between the evans index and cognitive performance in non-disabled, stroke-free, community-dwelling older adults. A population-based study. Clin Neurol Neurosurg 2018; 169:139-143. [DOI: 10.1016/j.clineuro.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/03/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
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Edsbagge M, Andreasson U, Ambarki K, Wikkelsø C, Eklund A, Blennow K, Zetterberg H, Tullberg M. Alzheimer's Disease-Associated Cerebrospinal Fluid (CSF) Biomarkers do not Correlate with CSF Volumes or CSF Production Rate. J Alzheimers Dis 2018; 58:821-828. [PMID: 28505972 DOI: 10.3233/jad-161257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuropathologically, Alzheimer's disease (AD) is characterized by accumulation of a 42 amino acid peptide called amyloid-β (Aβ42) in extracellular senile plaques together with intraneuronal inclusions of hyperphosphorylated tau protein in neurofibrillary tangles and neuronal degeneration. These changes are reflected in the cerebrospinal fluid (CSF), the volumes and production rates of which vary considerably between individuals, by reduced concentration of Aβ42, increased concentration of phosphorylated tau (P-tau) protein, and increased concentration of total tau (T-tau) protein, respectively. OBJECTIVE To examine the outstanding question if CSF concentrations of AD associated biomarkers are influenced by variations in CSF volumes, CSF production rate, and intracranial pressure in healthy individuals. METHODS CSF concentrations of Aβ42, P-tau, and T-tau, as well as a number of other AD-related CSF biomarkers were analyzed together with intracranial subarachnoid, ventricular, and spinal CSF volumes, as assessed by magnetic resonance imaging volumetric measurements, and CSF production rate in 19 cognitively normal healthy subjects (mean age 70.6, SD 3.6 years). RESULTS Negative correlations were seen between the concentrations of three CSF biomarkers (albumin ratio, Aβ38, and Aβ40), and ventricular CSF volume, but apart from this finding, no significant correlations were observed. CONCLUSION These results speak against inter-individual variations in CSF volume and production rate as important confounds in the AD biomarker research field.
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Affiliation(s)
- Mikael Edsbagge
- Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Andreasson
- Department of Psychiatry and Neurochemistry, Clinical Neurochemistry Laboratory,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Khalid Ambarki
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Carsten Wikkelsø
- Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Clinical Neurochemistry Laboratory,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Clinical Neurochemistry Laboratory,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,UCL Institute of Neurology, Queen Square, London, UK
| | - Mats Tullberg
- Department of Clinical Neuroscience, Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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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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Staffaroni AM, Elahi FM, McDermott D, Marton K, Karageorgiou E, Sacco S, Paoletti M, Caverzasi E, Hess CP, Rosen HJ, Geschwind MD. Neuroimaging in Dementia. Semin Neurol 2017; 37:510-537. [PMID: 29207412 PMCID: PMC5823524 DOI: 10.1055/s-0037-1608808] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Although the diagnosis of dementia still is primarily based on clinical criteria, neuroimaging is playing an increasingly important role. This is in large part due to advances in techniques that can assist with discriminating between different syndromes. Magnetic resonance imaging remains at the core of differential diagnosis, with specific patterns of cortical and subcortical changes having diagnostic significance. Recent developments in molecular PET imaging techniques have opened the door for not only antemortem but early, even preclinical, diagnosis of underlying pathology. This is vital, as treatment trials are underway for pharmacological agents with specific molecular targets, and numerous failed trials suggest that earlier treatment is needed. This article provides an overview of classic neuroimaging findings as well as new and cutting-edge research techniques that assist with clinical diagnosis of a range of dementia syndromes, with an emphasis on studies using pathologically proven cases.
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Affiliation(s)
- Adam M. Staffaroni
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Fanny M. Elahi
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Dana McDermott
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Kacey Marton
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Elissaios Karageorgiou
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
- Neurological Institute of Athens, Athens, Greece
| | - Simone Sacco
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
- Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Matteo Paoletti
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
- Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Eduardo Caverzasi
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Christopher P. Hess
- Division of Neuroradiology, Department of Radiology, University of California, San Francisco (UCSF), California
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
| | - Michael D. Geschwind
- Department of Neurology, Memory and Aging Center, University of California, San Francisco (UCSF), San Francisco, California
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Liu H, Yang C, Yang J, Xu Y. Pediatric Chiari malformation type I: long-term outcomes following small-bone-window posterior fossa decompression with autologous-fascia duraplasty. Exp Ther Med 2017; 14:5652-5658. [PMID: 29285106 DOI: 10.3892/etm.2017.5211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 03/03/2017] [Indexed: 12/14/2022] Open
Abstract
Chiari malformation type I (CM-I) is a common hindbrain disorder that is associated with deformity and elongation of the cerebellar tonsils. Although CM-I occurs in both pediatric and adult patients, its prevalence, clinical features and management in the pediatric population are not well defined. The current study evaluated a consecutive case series of 92 children (38 females and 54 males) who were diagnosed with congenital CM-I. All patients underwent small-bone-window posterior fossa decompression with autologous-fascia duraplasty. Clinical and radiological features were analyzed and long-term follow-up data were recorded. Risk factors associated with clinical outcomes were investigated using comprehensive statistical methods. Out of the 92 children, 11 (12.0%) were asymptomatic. Associated ventricular dilation was observed in 24 children (26.1%) and concomitant syringomyelia was observed in 72 children (78.3%). A total of 44 children (47.8%) showed scoliosis on plain films. Follow-up data (mean duration, 88.6 months) were available for all patients. Syringomyelia was absent or markedly reduced in 56 patients (77.8%). Symptoms were alleviated in 66 patients, remained unchanged in 12 patients and progressed in 3 patients. Statistical analysis indicated that the cerebellar tonsillar descent (CTD) grade, basilar invagination and platybasia influenced the clinical outcome (P<0.05). In conclusion, early recognition and surgical treatment of CM-I in pediatric patients can lead to good outcomes. The current results suggested that small-bone-window posterior fossa decompression with autologous-fascia duraplasty was an effective safe treatment option with a low complication rate. High CTD grade, basilar invagination and platybasia were indicated to be predictors of poor clinical prognosis.
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Affiliation(s)
- Hai Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Chenlong Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jun Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Brix MK, Westman E, Simmons A, Ringstad GA, Eide PK, Wagner-Larsen K, Page CM, Vitelli V, Beyer MK. The Evans' Index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly. Eur J Radiol 2017; 95:28-32. [PMID: 28987681 DOI: 10.1016/j.ejrad.2017.07.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Assessment of ventricular enlargement is subjective and based on the radiologist's experience. Linear indices, such as the Evans Index (EI), have been proposed as markers of ventricular volume with an EI≥0.3 indicating pathologic ventricular enlargement in any subject. However, normal range for EI measured on magnetic resonance imaging (MRI) scans are lacking in healthy elderly according to age and sex. We propose new age and sex specific cut-off values for ventricular enlargement in the elderly population. MATERIALS AND METHODS 534 participants (53% women) aged 65-84 years; 226 patients with Alzheimer's disease (AD), and 308 healthy elderly controls (CTR) from the AddNeuroMed and ADNI studies were included. The cut-off for pathological ventricular enlargement was estimated from healthy elderly categorized into age groups of 5 years range and defined as EI 97,5 percentile (mean+2SD). Cut-off values were tested on patients with Alzheimer's disease and a small sample of patients with probable idiopathic normal pressure hydrocephalus (iNPH) to assess the sensitivity. RESULTS The range of the EI in healthy elderly is wide and 29% of the CTR had an EI of 0.3 or greater. The EI increases with age in both CTR and AD, and the overall EI for women were lower than for men (p<0.001). New EI cut off values for male/female: 65-69 years 0.34/0.32, 70-74 years 0.36/0.33, 75-79 years 0.37/0.34 and 80-84 years 0.37/0.36. When applying the proposed cut-offs for EI in men and women aged 65-84, they differentiated between iNPH and CTR with a sensitivity of 80% and for different age and sex categories of AD and CTR with a sensitivity and specificity of 0-27% and 91-98%, respectively. CONCLUSION The range of the EI measurements in healthy elderly is wide, and a cut-off value of 0.3 cannot be used to differentiate between normal and enlarged ventricles in individual cases. The proposed EI thresholds from the present study show good sensitivity for the iNPH diagnosis.
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Affiliation(s)
- Maiken K Brix
- Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Institute of Psychiatry, King's College London, UK
| | - Andrew Simmons
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Institute of Psychiatry, King's College London, UK; NIHR Biomedical Research Centre for Mental Health, London, UK; NIHR Biomedical Research Unit for Dementia, London, UK
| | - Geir Andre Ringstad
- Department of Radiology and Nuclear Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Eide
- Department of Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Christian M Page
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Division of Surgery and Clinical Neuroscience, Oslo University hospital, Oslo, Norway
| | - Valeria Vitelli
- Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Feasibility of Simple Linear Measurements to Determine Ventricular Enlargement in Patients With Idiopathic Normal Pressure Hydrocephalus. J Craniofac Surg 2017; 27:e462-5. [PMID: 27315311 DOI: 10.1097/scs.0000000000002779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and reproducibility of linear measurements for determining ventricular enlargement in patients with idiopathic normal pressure hydrocephalus (iNPH) and their correlation to ventricular volume (VV). METHODS Preoperative brain computed tomography scans were retrospectively evaluated in 36 patients with iNPH. The quantitative markers of Evan index (EI), VV, frontal and occipital horn ratio (FOR), modified cella media index (mCMI), third ventricular width (TVW), temporal horn width (TPH), frontal horn width (FHW), and callosal angle (CA) at the posterior commissure (PC) were independently measured by a neurosurgeon and a radiologist. Intraclass correlation coefficients were calculated to establish inter-rater agreement among the 2 investigators. Pearson correlation coefficients were used to assess the relationship of each linear measurement with total VV. RESULTS The overall inter-rater agreement among investigators was almost perfect for EI, VV, FOR, mCMI, TVW, substantial for FHW and moderate for TPH, and CA at PC. Pearson correlation coefficients showed excellent correlation between mCMI and VV. Moderate correlation was found between the VV and FHW, TVW, FOR, EI, and CA at PC. Fair correlation was found between the VV and TPH. CONCLUSION Simple linear measurements could serve as effective alternative to volumetric analysis to determine ventricular size in patients with iNPH. The quantitative marker of mCMI is more reasonable and accurate than EI, FOR, and other simple linear measurements.
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Miskin N, Patel H, Franceschi AM, Ades-Aron B, Le A, Damadian BE, Stanton C, Serulle Y, Golomb J, Gonen O, Rusinek H, George AE. Diagnosis of Normal-Pressure Hydrocephalus: Use of Traditional Measures in the Era of Volumetric MR Imaging. Radiology 2017; 285:197-205. [PMID: 28498794 DOI: 10.1148/radiol.2017161216] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the diagnostic performance of the callosal angle (CA) and Evans index (EI) measures and to determine their role versus automated volumetric methods in clinical radiology. Materials and Methods Magnetic resonance (MR) examinations performed before surgery (within 1-5 months of the MR examination) in 36 shunt-responsive patients with normal-pressure hydrocephalus (NPH; mean age, 75 years; age range, 58-87 years; 26 men, 10 women) and MR examinations of age- and sex-matched patients with Alzheimer disease (n = 34) and healthy control volunteers (n = 36) were studied. Three blinded observers independently measured EI and CA for each patient. Volumetric segmentation of global gray matter, white matter, ventricles, and hippocampi was performed by using software. These measures were tested by using multivariable logistic regression models to determine which combination of metrics is most accurate in diagnosis. Results The model that used CA and EI demonstrated 89.6%-93.4% accuracy and average area under the curve of 0.96 in differentiating patients with NPH from patients without NPH (ie, Alzheimer disease and healthy control). The regression model that used volumetric predictors of gray matter and white matter was 94.3% accurate. Conclusion CA and EI may serve as a screening tool to help the radiologist differentiate patients with NPH from patients without NPH, which would allow for designation of patients for further volumetric assessment. © RSNA, 2017.
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Affiliation(s)
- Nityanand Miskin
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Hersh Patel
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Ana M Franceschi
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Benjamin Ades-Aron
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Alexander Le
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Brianna E Damadian
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Christian Stanton
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Yafell Serulle
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - James Golomb
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Oded Gonen
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Henry Rusinek
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
| | - Ajax E George
- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
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- From the Dept of Radiology, Brigham and Women's Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P.); Center for Biomedical Imaging, Dept of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016 (A.M.F., B.A.A., A.L., C.S., O.G., H.R., A.E.G.); Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY (B.E.D.); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S.); and Dept of Neurology, New York University School of Medicine, New York, NY (J.G.)
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Qvarlander S, Ambarki K, Wåhlin A, Jacobsson J, Birgander R, Malm J, Eklund A. Cerebrospinal fluid and blood flow patterns in idiopathic normal pressure hydrocephalus. Acta Neurol Scand 2017; 135:576-584. [PMID: 27388230 DOI: 10.1111/ane.12636] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Increased aqueduct cerebrospinal fluid (CSF) flow pulsatility and, recently, a reversed CSF flow in the aqueduct have been suggested as hallmarks of idiopathic normal pressure hydrocephalus (INPH). However, these findings have not been adequately confirmed. Our objective was to investigate the flow of blood and CSF in INPH, as compared to healthy elderly, in order to clarify which flow parameters are related to the INPH pathophysiology. MATERIALS AND METHODS Sixteen INPH patients (73 years) and 35 healthy subjects (72 years) underwent phase-contrast magnetic resonance imaging (MRI). Measurements included aqueduct and cervical CSF flow, total arterial inflow (tCBF; i.e. carotid + vertebral arteries), and internal jugular vein flow. Flow pulsatility, net flow, and flow delays were compared (multiple linear regression, correcting for sex and age). RESULTS Aqueduct stroke volume was higher in INPH than healthy (148±95 vs 90±50 mL, P<.05). Net aqueduct CSF flow was similar in magnitude and direction. The cervical CSF stroke volume was lower (P<.05). The internal carotid artery net flow was lower in INPH (P<.05), although tCBF was not. No differences were found in internal jugular vein flow or flow delays. CONCLUSIONS The typical flow of blood and CSF in INPH was mainly characterized by increased CSF pulsatility in the aqueduct and reduced cervical CSF pulsatility. The direction of mean net aqueduct CSF flow was from the third to the fourth ventricle. Our findings may reflect the altered distribution of intracranial CSF volume in INPH, although the causality of these relationships is unclear.
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Affiliation(s)
- S. Qvarlander
- Department of Radiation Sciences; Umeå University; Umeå Sweden
- Centre for Biomedical Engineering and Physics; Umeå University; Umeå Sweden
| | - K. Ambarki
- Department of Radiation Sciences; Umeå University; Umeå Sweden
- Centre for Biomedical Engineering and Physics; Umeå University; Umeå Sweden
| | - A. Wåhlin
- Department of Radiation Sciences; Umeå University; Umeå Sweden
- Umeå Centre for Functional Brain Imaging; Umeå University; Umeå Sweden
| | - J. Jacobsson
- Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå Sweden
| | - R. Birgander
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Malm
- Department of Pharmacology and Clinical Neuroscience; Umeå University; Umeå Sweden
| | - A. Eklund
- Department of Radiation Sciences; Umeå University; Umeå Sweden
- Centre for Biomedical Engineering and Physics; Umeå University; Umeå Sweden
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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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Schob S, Weiß A, Dieckow J, Richter C, Pirlich M, Voigt P, Surov A, Hoffmann KT, Quaeschling U, Preuß M. Correlations of Ventricular Enlargement with Rheologically Active Surfactant Proteins in Cerebrospinal Fluid. Front Aging Neurosci 2017; 8:324. [PMID: 28101052 PMCID: PMC5209370 DOI: 10.3389/fnagi.2016.00324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/14/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose: Surfactant proteins (SPs) are involved in the regulation of rheological properties of body fluids. Concentrations of SPs are altered in the cerebrospinal fluid (CSF) of hydrocephalus patients. The common hallmark of hydrocephalus is enlargement of the brain ventricles. The relationship of both phenomena has not yet been investigated. The aim of this study was to evaluate the association between SP concentrations in the CSF and enlargement of the brain ventricles. Procedures: Ninty-six individuals (41 healthy subjects and 55 hydrocephalus patients) were included in this retrospective analysis. CSF specimens were analyzed for SP-A, SP-B, SP-C and SP-D concentrations by use of enzyme linked immunosorbent assays (ELISA). Ventricular enlargement was quantified in T2 weighted (T2w) magnetic resonance imaging (MRI) sections using an uni-dimensional (Evans’ Index) and a two-dimensional approach (lateral ventricles area index, LVAI). Results: CSF-SP concentrations (mean ± standard deviation in ng/ml) were as follows: SP-A 0.71 ± 0.58, SP-B 0.18 ± 0.43, SP-C 0.89 ± 0.77 and SP-D 7.4 ± 5.4. Calculated values of Evans’ Index were 0.37 ± 0.11, a calculation of LVAI resulted in 0.18 ± 0.15 (each mean ± standard deviation). Significant correlations were identified for Evans’ Index with SP-A (r = 0.388, p < 0.001) and SP-C (r = 0.392, p < 0.001), LVAI with SP-A (r = 0.352, p = 0.001), SP-C (r = 0.471, p < 0.001) and SP-D (r = 0.233, p = 0.025). Furthermore, SP-C showed a clear inverse correlation with age (r = −0.357, p = 0.011). Conclusion: The present study confirmed significant correlations between SPs A, C and D in the CSF with enlargement of the inner CSF spaces. In conclusion, SPs clearly play an important role for CSF rheology. CSF rheology is profoundly altered in hydrocephalic diseases, however, diagnosis and therapy of hydrocephalic conditions are still almost exclusively based on ventricular enlargement. Until now it was unclear, whether the stage of the disease, as represented by the extent of ventricular dilatation, is somehow related to the changes of SP levels in the CSF. Our study is the first to provide evidence that increasing ventriculomegaly is accompanied by enhanced changes of rheologically active compounds in the CSF and therefore introduces completely new aspects for hydrocephalus testing and conservative therapeutic approaches.
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Affiliation(s)
- Stefan Schob
- Department of Neuroradiology, Leipzig University Leipzig, Germany
| | - Alexander Weiß
- Department of Neuroradiology, Leipzig University Leipzig, Germany
| | - Julia Dieckow
- Department of Ophthalmology, Leipzig University Leipzig, Germany
| | - Cindy Richter
- Institute of Anatomy, Leipzig University Leipzig, Germany
| | - Mandy Pirlich
- Department of Neurology, Leipzig University Leipzig, Germany
| | - Peter Voigt
- Department of Neuroradiology, Leipzig University Leipzig, Germany
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital Leipzig, Germany
| | | | - Ulf Quaeschling
- Department of Neuroradiology, Leipzig University Leipzig, Germany
| | - Matthias Preuß
- Department of Neurosurgery, Leipzig University Leipzig, Germany
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50
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Normative values for Evan's index on CT scan for apparently healthy individuals. J ANAT SOC INDIA 2015. [DOI: 10.1016/j.jasi.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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