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Karki P, Murphy MC, Cogswell PM, Senjem ML, Graff-Radford J, Elder BD, Perry A, Graffeo CS, Meyer FB, Jack CR, Ehman RL, Huston J. Prediction of Surgical Outcomes in Normal Pressure Hydrocephalus by MR Elastography. AJNR Am J Neuroradiol 2024; 45:328-334. [PMID: 38272572 DOI: 10.3174/ajnr.a8108] [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: 07/24/2023] [Accepted: 11/21/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND PURPOSE Normal pressure hydrocephalus is a treatable cause of dementia associated with distinct mechanical property signatures in the brain as measured by MR elastography. In this study, we tested the hypothesis that specific anatomic features of normal pressure hydrocephalus are associated with unique mechanical property alterations. Then, we tested the hypothesis that summary measures of these mechanical signatures can be used to predict clinical outcomes. MATERIALS AND METHODS MR elastography and structural imaging were performed in 128 patients with suspected normal pressure hydrocephalus and 44 control participants. Patients were categorized into 4 subgroups based on their anatomic features. Surgery outcome was acquired for 68 patients. Voxelwise modeling was performed to detect regions with significantly different mechanical properties between each group. Mechanical signatures were summarized using pattern analysis and were used as features to train classification models and predict shunt outcomes for 2 sets of feature spaces: a limited 2D feature space that included the most common features found in normal pressure hydrocephalus and an expanded 20-dimensional (20D) feature space that included features from all 4 morphologic subgroups. RESULTS Both the 2D and 20D classifiers performed significantly better than chance for predicting clinical outcomes with estimated areas under the receiver operating characteristic curve of 0.66 and 0.77, respectively (P < .05, permutation test). The 20D classifier significantly improved the diagnostic OR and positive predictive value compared with the 2D classifier (P < .05, permutation test). CONCLUSIONS MR elastography provides further insight into mechanical alterations in the normal pressure hydrocephalus brain and is a promising, noninvasive method for predicting surgical outcomes in patients with normal pressure hydrocephalus.
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Affiliation(s)
- Pragalv Karki
- From the Department of Radiology (P.K., M.C.M., P.M.C., M.L.S., J.G.-R., C.R.J., R.L.E., J.H.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Matthew C Murphy
- From the Department of Radiology (P.K., M.C.M., P.M.C., M.L.S., J.G.-R., C.R.J., R.L.E., J.H.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Petrice M Cogswell
- From the Department of Radiology (P.K., M.C.M., P.M.C., M.L.S., J.G.-R., C.R.J., R.L.E., J.H.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Matthew L Senjem
- From the Department of Radiology (P.K., M.C.M., P.M.C., M.L.S., J.G.-R., C.R.J., R.L.E., J.H.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jonathan Graff-Radford
- Department of Neurology (J.G.-R.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin D Elder
- Department of Neurologic Surgery (B.D.E., C.S.G., F.B.M.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Avital Perry
- Department of Neurosurgery (A.P.), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Christopher S Graffeo
- Department of Neurologic Surgery (B.D.E., C.S.G., F.B.M.), Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Neurosurgery (C.S.G.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Fredric B Meyer
- Department of Neurologic Surgery (B.D.E., C.S.G., F.B.M.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Clifford R Jack
- From the Department of Radiology (P.K., M.C.M., P.M.C., M.L.S., J.G.-R., C.R.J., R.L.E., J.H.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Richard L Ehman
- From the Department of Radiology (P.K., M.C.M., P.M.C., M.L.S., J.G.-R., C.R.J., R.L.E., J.H.), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - John Huston
- From the Department of Radiology (P.K., M.C.M., P.M.C., M.L.S., J.G.-R., C.R.J., R.L.E., J.H.), Mayo Clinic College of Medicine, Rochester, Minnesota
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Haller S, Jäger HR, Vernooij MW, Barkhof F. Neuroimaging in Dementia: More than Typical Alzheimer Disease. Radiology 2023; 308:e230173. [PMID: 37724973 DOI: 10.1148/radiol.230173] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Alzheimer disease (AD) is the most common cause of dementia. The prevailing theory of the underlying pathology assumes amyloid accumulation followed by tau protein aggregation and neurodegeneration. However, the current antiamyloid and antitau treatments show only variable clinical efficacy. Three relevant points are important for the radiologic assessment of dementia. First, besides various dementing disorders (including AD, frontotemporal dementia, and dementia with Lewy bodies), clinical variants and imaging subtypes of AD include both typical and atypical AD. Second, atypical AD has overlapping radiologic and clinical findings with other disorders. Third, the diagnostic process should consider mixed pathologies in neurodegeneration, especially concurrent cerebrovascular disease, which is frequent in older age. Neuronal loss is often present at, or even before, the onset of cognitive decline. Thus, for effective emerging treatments, early diagnosis before the onset of clinical symptoms is essential to slow down or stop subsequent neuronal loss, requiring molecular imaging or plasma biomarkers. Neuroimaging, particularly MRI, provides multiple imaging parameters for neurodegenerative and cerebrovascular disease. With emerging treatments for AD, it is increasingly important to recognize AD variants and other disorders that mimic AD. Describing the individual composition of neurodegenerative and cerebrovascular disease markers while considering overlapping and mixed diseases is necessary to better understand AD and develop efficient individualized therapies.
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Affiliation(s)
- Sven Haller
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (S.H.); Tanta University, Faculty of Medicine, Tanta, Egypt (S.H.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology (H.R.J., F.B.), and Centre for Medical Image Computing, Institute of Healthcare Engineering (F.B.), University College London, London, England; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England (H.R.J.); Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (M.W.V.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - Hans Rolf Jäger
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (S.H.); Tanta University, Faculty of Medicine, Tanta, Egypt (S.H.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology (H.R.J., F.B.), and Centre for Medical Image Computing, Institute of Healthcare Engineering (F.B.), University College London, London, England; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England (H.R.J.); Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (M.W.V.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - Meike W Vernooij
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (S.H.); Tanta University, Faculty of Medicine, Tanta, Egypt (S.H.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology (H.R.J., F.B.), and Centre for Medical Image Computing, Institute of Healthcare Engineering (F.B.), University College London, London, England; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England (H.R.J.); Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (M.W.V.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
| | - Frederik Barkhof
- From the Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (S.H.); Tanta University, Faculty of Medicine, Tanta, Egypt (S.H.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology (H.R.J., F.B.), and Centre for Medical Image Computing, Institute of Healthcare Engineering (F.B.), University College London, London, England; Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, England (H.R.J.); Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (M.W.V.); and Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands (F.B.)
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Nakamura N, Ushida T, Onoda A, Ueda K, Miura R, Suzuki T, Katsuki S, Mizutani H, Yoshida K, Tano S, Iitani Y, Imai K, Hayakawa M, Kajiyama H, Sato Y, Kotani T. Altered offspring neurodevelopment in an L-NAME-induced preeclampsia rat model. Front Pediatr 2023; 11:1168173. [PMID: 37520045 PMCID: PMC10373593 DOI: 10.3389/fped.2023.1168173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction To investigate the mechanism underlying the increased risk of subsequent neurodevelopmental disorders in children born to mothers with preeclampsia, we evaluated the neurodevelopment of offspring of a preeclampsia rat model induced by the administration of N-nitro-L-arginine methyl ester (L-NAME) and identified unique protein signatures in the offspring cerebrospinal fluid. Methods Pregnant rats received an intraperitoneal injection of L-NAME (250 mg/kg/day) during gestational days 15-20 to establish a preeclampsia model. Behavioral experiments (negative geotaxis, open-field, rotarod treadmill, and active avoidance tests), immunohistochemistry [anti-neuronal nuclei (NeuN) staining in the hippocampal dentate gyrus and cerebral cortex on postnatal day 70], and proteome analysis of the cerebrospinal fluid on postnatal day 5 were performed on male offspring. Results Offspring of the preeclampsia dam exhibited increased growth restriction at birth (52.5%), but showed postnatal catch-up growth on postnatal day 14. Several behavioral abnormalities including motor development and vestibular function (negative geotaxis test: p < 0.01) in the neonatal period; motor coordination and learning skills (rotarod treadmill test: p = 0.01); and memory skills (active avoidance test: p < 0.01) in the juvenile period were observed. NeuN-positive cells in preeclampsia rats were significantly reduced in both the hippocampal dentate gyrus and cerebral cortex (p < 0.01, p < 0.01, respectively). Among the 1270 proteins in the cerebrospinal fluid identified using liquid chromatography-tandem mass spectrometry, 32 were differentially expressed. Principal component analysis showed that most cerebrospinal fluid samples achieved clear separation between preeclampsia and control rats. Pathway analysis revealed that differentially expressed proteins were associated with endoplasmic reticulum translocation, Rab proteins, and ribosomal proteins, which are involved in various nervous system disorders including autism spectrum disorders, schizophrenia, and Alzheimer's disease. Conclusion The offspring of the L-NAME-induced preeclampsia model rats exhibited key features of neurodevelopmental abnormalities on behavioral and pathological examinations similar to humans. We found altered cerebrospinal fluid protein profiling in this preeclampsia rat, and the unique protein signatures related to endoplasmic reticulum translocation, Rab proteins, and ribosomal proteins may be associated with subsequent adverse neurodevelopment in the offspring.
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Affiliation(s)
- Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Obstetrics and Gynecology, Anjo Kosei Hospital, Aichi, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Atsuto Onoda
- Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan
| | - Kazuto Ueda
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Ryosuke Miura
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Toshihiko Suzuki
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Satoru Katsuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidesuke Mizutani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kosuke Yoshida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sho Tano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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Hidaka Y, Hashimoto M, Suehiro T, Fukuhara R, Ishikawa T, Tsunoda N, Koyama A, Honda K, Miyagawa Y, Yoshiura K, Boku S, Ishii K, Ikeda M, Takebayashi M. Impact of age on the cerebrospinal fluid spaces: high-convexity and medial subarachnoid spaces decrease with age. Fluids Barriers CNS 2022; 19:82. [PMID: 36307853 PMCID: PMC9615391 DOI: 10.1186/s12987-022-00381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background Impaired cerebrospinal fluid (CSF) dynamics may contribute to the pathophysiology of neurodegenerative diseases, and play a crucial role in brain health in older people; nonetheless, such age-related changes have not been well elucidated. Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) is a neuroimaging phenotype of idiopathic normal-pressure hydrocephalus, originating from impaired CSF dynamics, and closely associated with aging. This study aimed to investigate the pathophysiology of DESH and determine age-related changes in CSF dynamics. Methods Using magnetic resonance imaging, we investigated the pathophysiology of DESH by quantitatively evaluating the volumes of DESH-related regions (ventricles [VS], Sylvian fissure [SF], and subarachnoid spaces at high convexity and midline [SHM]) and brain parenchyma in community-dwelling individuals aged ≥ 65 years. DESH-related regions were assessed using a visual rating scale, and volumes measured using voxel-based morphometry. Brain parenchyma volumes were measured using FreeSurfer software. Results Data from 1,356 individuals were analyzed, and 25 (1.8%) individuals had DESH. Regarding the relationships between the volume of each CSF space and age, VS and SF volumes increased with age, whereas SHM volume did not increase. VS and SF volumes increased as the whole brain volume decreased, whereas SHM volume did not increase even if the whole brain volume decreased; that is, SHM did not expand even if brain atrophy progressed. Moreover, lower Mini-Mental State Examination scores were significantly associated with lower SHM volume and higher VS volume. These associations remained significant even when individuals with DESH were excluded. Conclusions This study showed that the volume of high-convexity and medial subarachnoid spaces did not expand and tended to decrease with age; the human brain continuously progresses toward a “DESH-like” morphology with aging in community-dwelling older persons (i.e., DESH might be an “accelerated aging stage” rather than an “age-related disorder”). Our results indicated that brain atrophy may be associated with the development of “DESH-like” morphology. In addition, this morphological change, as well as brain atrophy, is an important condition associated with cognitive decline in older adults. Our findings highlight the importance of investigating the aging process of CSF dynamics in the human brain to preserve brain health in older people. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-022-00381-5.
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Camerucci E, Graff-Radford J, Jones DT, Elder BD, Gunter JL, Cutsforth-Gregory JK, Botha H, Murphy MC, Johnson DR, Davidge-Pitts C, Jack CR, Huston J, Cogswell PM. Change in Morphological Features of Enlarged Subarachnoid Spaces Following Treatment in Idiopathic Normal Pressure Hydrocephalus. J Magn Reson Imaging 2022; 57:1443-1450. [PMID: 35894392 DOI: 10.1002/jmri.28340] [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: 03/21/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Focally enlarged sulci (FES) are areas of proposed extraventricular fluid entrapment that may occur within idiopathic normal pressure hydrocephalus (iNPH) with radiographic evidence of disproportionately enlarged subarachnoid-space hydrocephalus (DESH), and should be differentiated from atrophy. PURPOSE To evaluate for change in FES size and pituitary height after shunt placement in iNPH. STUDY TYPE Retrospective. SUBJECTS A total of 125 iNPH patients who underwent shunt surgery and 40 age-matched controls. FIELD STRENGTH/SEQUENCE 1.5 T and 3 T. Axial T2w FLAIR, 3D T1w MPRAGE, 2D sagittal T1w. ASSESSMENT FES were measured in three dimensions and volume was estimated by assuming an ellipsoid shape. Pituitary gland height was measured in the mid third of the gland in iNPH patients and controls. STATISTICAL TESTS Wilcoxon signed-rank test for comparisons between MRI measurements; Wilcoxon rank sum test for comparison of cases/controls. Significance level was P < 0.05. RESULTS Fifty percent of the patients had FES. FES volume significantly decreased between the pre and first postshunt MRI by a median of 303 mm3 or 30.0%. Pituitary gland size significantly increased by 0.48 mm or 14.4%. FES decreased significantly by 190 mm3 or 23.1% and pituitary gland size increased significantly by 0.25 mm or 6% between the first and last postshunt MRI. DATA CONCLUSION Decrease in size of FES after shunt placement provides further evidence that these regions are due to disordered cerebrospinal fluid (CSF) dynamics and should not be misinterpreted as atrophy. A relatively smaller pituitary gland in iNPH patients that normalizes after shunt is a less-well recognized feature of altered CSF dynamics. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
| | | | - David T Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Davidge-Pitts
- Department of Medicine, Division of Endocrinology, Diabetes, Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Langheinrich T, Chen C, Thomas O. Update on the Cognitive Presentations of iNPH for Clinicians. Front Neurol 2022; 13:894617. [PMID: 35937049 PMCID: PMC9350547 DOI: 10.3389/fneur.2022.894617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
This mini-review focuses on cognitive impairment in iNPH. This symptom is one of the characteristic triad of symptoms in a condition long considered to be the only treatable dementia. We present an update on recent developments in clinical, neuropsychological, neuroimaging and biomarker aspects. Significant advances in our understanding have been made, notably regarding biomarkers, but iNPH remains a difficult diagnosis. Stronger evidence for permanent surgical treatment is emerging but selection for treatment remains challenging, particularly with regards to cognitive presentations. Encouragingly, there has been increasing interest in iNPH, but more research is required to better define the underlying pathology and delineate it from overlapping conditions, in order to inform best practise for the clinician managing the cognitively impaired patient. In the meantime, we strongly encourage a multidisciplinary approach and a structured service pathway to maximise patient benefit.
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Affiliation(s)
- Tobias Langheinrich
- Department of Neurology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- *Correspondence: Tobias Langheinrich
| | - Cliff Chen
- Department of Neuropsychology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Owen Thomas
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
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Neuroimaging Findings in a Patient with Anti-IgLON5 Disease: Cerebrospinal Fluid Dynamics Abnormalities. Diagnostics (Basel) 2022; 12:diagnostics12040849. [PMID: 35453897 PMCID: PMC9028205 DOI: 10.3390/diagnostics12040849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Anti-IgLON5 disease is a recently described autoimmune neurodegenerative disorder characterized by insidious onset, slow progression and a variety of neurological features. Neuroimaging in most patients with anti-IgLON5 disease is normal or shows nonspecific findings. Here, we report a case of anti-IgLON5 disease presenting with parkinsonism, falls, sleep problems with severe nocturnal dyspnea attacks, dysphagia, and dysautonomia. Imaging findings were initially suggestive of progressive supranuclear palsy. An altered cerebrospinal fluid dynamic was found on an MRI as well as high-convexity hyperperfusion on a brain SPECT. Further case descriptions with neuroimaging are required to characterize cerebral and cerebrospinal fluid dynamics abnormalities in this rare condition.
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8
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Graff-Radford J, Jones DT, Wiste HJ, Cogswell PM, Weigand SD, Lowe V, Elder BD, Vemuri P, Van Harten A, Mielke MM, Knopman DS, Graff-Radford NR, Petersen RC, Jack CR, Gunter JL. Cerebrospinal fluid dynamics and discordant amyloid biomarkers. Neurobiol Aging 2022; 110:27-36. [PMID: 34844077 PMCID: PMC8758540 DOI: 10.1016/j.neurobiolaging.2021.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 02/03/2023]
Abstract
Do MRI-based metrics of a CSF-dynamics disorder, disproportionately enlarged subarachnoid-space hydrocephalus (DESH), correlate with discordant amyloid biomarkers (low CSF β-amyloid 1-42, normal Aβ-PET scan)? Individuals ≥50 years from the Mayo Clinic Study of Aging, with MRI, 11C-Pittsburgh compound B (Aβ) PET scans, and CSF phosphorylated-tau protein and Aβ42, were categorized into 4 groups: normal and/or abnormal by CSF β-amyloid 1-42 and Aβ amyloid PET. Within groups, we noted MRI patterns of CSF-dynamics disorders and Aβ-PET accumulation-change rate. One-hundred participants (21%) in the abnormal-CSF and/or normal-PET group had highest DESH-pattern scores and lowest CSF-phosphorylated-tau levels. Among normal amyloid-PET individuals, a 1-unit DESH-pattern score increase correlated with 30%-greater odds of abnormal amyloid CSF after age, and sex adjustment. Mean rate over time of amyloid-PET accumulation in abnormal-CSF and/or normal-PET individuals approximated individuals with normal amyloid values. Adjusting for phosphorylated-tau, abnormal CSF-amyloid and/or normal amyloid-PET individuals had higher mean amyloid-PET accumulation rates than normal individuals. CSF dynamics disorders confound β-amyloid and phosphorylated-tau CSF-biomarker interpretation.
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Affiliation(s)
- Jonathan Graff-Radford
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - David T. Jones
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Heather J. Wiste
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Petrice M. Cogswell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Stephen D. Weigand
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Val Lowe
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Benjamin D. Elder
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA,Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Argonde Van Harten
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Michelle M. Mielke
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - David S. Knopman
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Neill R. Graff-Radford
- Department of Enterprise Application Services, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Ronald C. Petersen
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Clifford R. Jack
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA
| | - Jeffrey L. Gunter
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224 USA
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9
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Alzheimer resemblance atrophy index, BrainAGE, and normal pressure hydrocephalus score in the prediction of subtle cognitive decline: added value compared to existing MR imaging markers. Eur Radiol 2022; 32:7833-7842. [PMID: 35486172 PMCID: PMC9668758 DOI: 10.1007/s00330-022-08798-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/09/2022] [Accepted: 04/01/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Established visual brain MRI markers for dementia include hippocampal atrophy (mesio-temporal atrophy MTA), white matter lesions (Fazekas score), and number of cerebral microbleeds (CMBs). We assessed whether novel quantitative, artificial intelligence (AI)-based volumetric scores provide additional value in predicting subsequent cognitive decline in elderly controls. METHODS A prospective study including 80 individuals (46 females, mean age 73.4 ± 3.5 years). 3T MR imaging was performed at baseline. Extensive neuropsychological assessment was performed at baseline and at 4.5-year follow-up. AI-based volumetric scores were derived from 3DT1: Alzheimer Disease Resemblance Atrophy Index (AD-RAI), Brain Age Gap Estimate (BrainAGE), and normal pressure hydrocephalus (NPH) index. Analyses included regression models between cognitive scores and imaging markers. RESULTS AD-RAI score at baseline was associated with Corsi (visuospatial memory) decline (10.6% of cognitive variability in multiple regression models). After inclusion of MTA, CMB, and Fazekas scores simultaneously, the AD-RAI score remained as the sole valid predictor of the cognitive outcome explaining 16.7% of its variability. Its percentage reached 21.4% when amyloid positivity was considered an additional explanatory factor. BrainAGE score was associated with Trail Making B (executive functions) decrease (8.5% of cognitive variability). Among the conventional MRI markers, only the Fazekas score at baseline was positively related to the cognitive outcome (8.7% of cognitive variability). The addition of the BrainAGE score as an independent variable significantly increased the percentage of cognitive variability explained by the regression model (from 8.7 to 14%). The addition of amyloid positivity led to a further increase in this percentage reaching 21.8%. CONCLUSIONS The AI-based AD-RAI index and BrainAGE scores have limited but significant added value in predicting the subsequent cognitive decline in elderly controls when compared to the established visual MRI markers of brain aging, notably MTA, Fazekas score, and number of CMBs. KEY POINTS • AD-RAI score at baseline was associated with Corsi score (visuospatial memory) decline. • BrainAGE score was associated with Trail Making B (executive functions) decrease. • AD-RAI index and BrainAGE scores have limited but significant added value in predicting the subsequent cognitive decline in elderly controls when compared to the established visual MRI markers of brain aging, notably MTA, Fazekas score, and number of CMBs.
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Cogswell PM, Murphy MC, Senjem ML, Botha H, Gunter JL, Elder BD, Graff-Radford J, Jones DT, Cutsforth-Gregory JK, Schwarz CG, Meyer FB, Huston J, Jack CR. Changes in Ventricular and Cortical Volumes following Shunt Placement in Patients with Idiopathic Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2021; 42:2165-2171. [PMID: 34674997 DOI: 10.3174/ajnr.a7323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE While changes in ventricular and extraventricular CSF spaces have been studied following shunt placement in patients with idiopathic normal pressure hydrocephalus, regional changes in cortical volumes have not. These changes are important to better inform disease pathophysiology and evaluation for copathology. The purpose of this work is to investigate changes in ventricular and cortical volumes in patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement. MATERIALS AND METHODS This is a retrospective cohort study of patients with idiopathic normal pressure hydrocephalus who underwent 3D T1-weighted MR imaging before and after ventriculoperitoneal shunt placement. Images were analyzed using tensor-based morphometry with symmetric normalization to determine the percentage change in ventricular and regional cortical volumes. Ventricular volume changes were assessed using the Wilcoxon signed rank test, and cortical volume changes, using a linear mixed-effects model (P < .05). RESULTS The study included 22 patients (5 women/17 men; mean age, 73 [SD, 6] years). Ventricular volume decreased after shunt placement with a mean change of -15.4% (P < .001). Measured cortical volume across all participants and cortical ROIs showed a mean percentage increase of 1.4% (P < .001). ROIs near the vertex showed the greatest percentage increase in volume after shunt placement, with smaller decreases in volume in the medial temporal lobes. CONCLUSIONS Overall, cortical volumes mildly increased after shunt placement in patients with idiopathic normal pressure hydrocephalus with the greatest increases in regions near the vertex, indicating postshunt decompression of the cortex and sulci. Ventricular volumes showed an expected decrease after shunt placement.
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Affiliation(s)
- P M Cogswell
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | - M C Murphy
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | | | - H Botha
- Neurology (H.B., J.G.-R., D.T.J., J.K.C.-G.)
| | - J L Gunter
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | - B D Elder
- Neurosurgery (B.D.E., F.B.M.)
- Biomedical Engineering (B.D.E.), Mayo Clinic, Rochester, Minnesota
| | | | - D T Jones
- Neurology (H.B., J.G.-R., D.T.J., J.K.C.-G.)
| | | | - C G Schwarz
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | | | - J Huston
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
| | - C R Jack
- From the Departments of Radiology (P.M.C., M.C.M., J.L.G., C.G.S., J.H., C.R.J.)
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Eide PK, Valnes LM, Lindstrøm EK, Mardal KA, Ringstad G. Direction and magnitude of cerebrospinal fluid flow vary substantially across central nervous system diseases. Fluids Barriers CNS 2021; 18:16. [PMID: 33794929 PMCID: PMC8017867 DOI: 10.1186/s12987-021-00251-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Several central nervous system diseases are associated with disturbed cerebrospinal fluid (CSF) flow patterns and have typically been characterized in vivo by phase-contrast magnetic resonance imaging (MRI). This technique is, however, limited by its applicability in space and time. Phase-contrast MRI has yet to be compared directly with CSF tracer enhanced imaging, which can be considered gold standard for assessing long-term CSF flow dynamics within the intracranial compartment. Methods Here, we studied patients with various CSF disorders and compared MRI biomarkers of CSF space anatomy and phase-contrast MRI at level of the aqueduct and cranio-cervical junction with dynamic intrathecal contrast-enhanced MRI using the contrast agent gadobutrol as CSF tracer. Tracer enrichment of cerebral ventricles was graded 0–4 by visual assessment. An intracranial pressure (ICP) score was used as surrogate marker of intracranial compliance. Results The study included 94 patients and disclosed marked variation of CSF flow measures across disease categories. The grade of supra-aqueductal reflux of tracer varied, with strong reflux (grades 3–4) in half of patients. Ventricular tracer reflux correlated with stroke volume and aqueductal CSF pressure gradient. CSF flow in the cerebral aqueduct was retrograde (from 4th to 3rd ventricle) in one third of patients, with estimated CSF net flow volume about 1.0 L/24 h. In the cranio-cervical junction, net flow was cranially directed in 78% patients, with estimated CSF net flow volume about 4.7 L/24 h. Conclusions The present observations provide in vivo quantitative evidence for substantial variation in direction and magnitude of CSF flow, with re-direction of aqueductal flow in communicating hydrocephalus, and significant extra-cranial CSF production. The grading of ventricular reflux of tracer shows promise as a clinical useful method to assess CSF flow pattern disturbances in patients. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00251-6.
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Affiliation(s)
- Per Kristian Eide
- Deptartment of Neurosurgery, Oslo University Hospital-Rikshospitalet, Nydalen, PB 4950, 0424, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Lars Magnus Valnes
- Deptartment of Neurosurgery, Oslo University Hospital-Rikshospitalet, Nydalen, PB 4950, 0424, Oslo, Norway
| | - Erika Kristina Lindstrøm
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - Kent-Andre Mardal
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Numerical Analysis and Scientific Computing, Simula Research Laboratory, Oslo, Norway
| | - Geir Ringstad
- Department. of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
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Cogswell PM, Weigand SD, Wiste HJ, Gunter JL, Graff-Radford J, Jones DT, Schwarz CG, Senjem ML, Knopman DS, Petersen RC, Jack CR. CSF dynamics as a predictor of cognitive progression. Neuroimage 2021; 232:117899. [PMID: 33631332 PMCID: PMC8237937 DOI: 10.1016/j.neuroimage.2021.117899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 11/25/2022] Open
Abstract
Disproportionately enlarged subarachnoid-space hydrocephalus (DESH), characterized by tight high convexity CSF spaces, ventriculomegaly, and enlarged Sylvian fissures, is thought to be an indirect marker of a CSF dynamics disorder. The clinical significance of DESH with regard to cognitive decline in a community setting is not yet well defined. The goal of this work is to determine if DESH is associated with cognitive decline. Participants in the population-based Mayo Clinic Study of Aging (MCSA) who met the following criteria were included: age ≥ 65 years, 3T MRI, and diagnosis of cognitively unimpaired or mild cognitive impairment at enrollment as well as at least one follow-up visit with cognitive testing. A support vector machine based method to detect the DESH imaging features on T1-weighted MRI was used to calculate a “DESH score ”, with positive scores indicating a more DESH-like imaging pattern. For the participants who were cognitively unimpaired at enrollment, a Cox proportional hazards model was fit with time defined as years from enrollment to first diagnosis of mild cognitive impairment or dementia, or as years to last known cognitively unimpaired diagnosis for those who did not progress. Linear mixed effects models were fit among all participants to estimate annual change in cognitive z scores for each domain (memory, attention, language, and visuospatial) and a global z score. For all models, covariates included age, sex, education, APOE genotype, cortical thickness, white matter hyperintensity volume, and total intracranial volume. The hazard of progression to cognitive impairment was an estimated 12% greater for a DESH score of +1 versus −1 (HR 1.12, 95% CI 0.97–1.31, p = 0.11). Global and attention cognition declined 0.015 (95% CI 0.005–0.025) and 0.016 (95% CI 0.005–0.028) z/year more, respectively, for a DESH score of +1 vs −1 (p = 0.01 and p = 0.02), with similar, though not statistically significant DESH effects in the other cognitive domains. Imaging features of disordered CSF dynamics are an independent predictor of subsequent cognitive decline in the MCSA, among other well-known factors including age, cortical thickness, and APOE status. Therefore, since DESH contributes to cognitive decline and is present in the general population, identifying individuals with DESH features may be important clinically as well as for selection in clinical trials.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Heather J Wiste
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | - David T Jones
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Information Technology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Ronald C Petersen
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Graff-Radford J, Knopman D, Jones D. Author response: Cerebrospinal fluid dynamics disorders: Relationship to Alzheimer biomarkers and cognition. Neurology 2020; 95:846. [DOI: 10.1212/wnl.0000000000010879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Allali G, Laticevschi T. Reader response: Cerebrospinal fluid dynamics disorders: Relationship to Alzheimer biomarkers and cognition. Neurology 2020; 95:845-846. [DOI: 10.1212/wnl.0000000000010872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cogswell PM, Graff-Radford J, Wurtz LI, Graff-Radford NR, Johnson DR, Hunt CH, Gunter JL, Cutsforth-Gregory JK, Jones DT, Elder BD, Huston Iii J, Jack CR. CSF dynamics disorders: Association of brain MRI and nuclear medicine cisternogram findings. NEUROIMAGE-CLINICAL 2020; 28:102481. [PMID: 33395973 PMCID: PMC7658703 DOI: 10.1016/j.nicl.2020.102481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022]
Abstract
MR features of DESH are associated with abnormalities on NM cisternogram. These finding support DESH as an indicator of a CSF dynamics disorder. Abnormal radiotracer distribution is more frequent in DESH vs ventriculomegaly or high convexity tight sulci alone. Abnormal radiotracer distribution is more frequent with ventriculomegaly or HCTS vs neither. These findings indicate that CSF dynamics disorders occur on a spectrum.
Disproportionately enlarged subarachnoid space hydrocephalus (DESH), characterized by ventriculomegaly, high convexity/midline tight sulci, and enlarged sylvian fissures on brain MRI has been increasingly recognized as a distinct diagnostic imaging entity that falls within the larger category of idiopathic normal pressure hydrocephalus. Normal pressure hydrocephalus has been previously characterized as a CSF dynamics disorder based on abnormalities on nuclear medicine cisternography: radiotracer in the lateral ventricles and absent or delayed ascent of radiotracer over the cerebral convexity. The purpose of this work was to evaluate for differences in nuclear medicine cisternography between patients with vs without DESH and thereby provide support for the concept that DESH is a structural imaging marker of a CSF dynamics disorder. The study included 102 patients (mean age 71 years, range 46–86, 38 females), 58 patients with cisternogram performed to evaluate suspected normal pressure hydrocephalus (mean age 73 years, range 46–86 years, 24 female) and 44 patients evaluated for headache (mean age 68 years, range 60–82 years, 14 female). All patients had an MRI of the brain performed within 13 months of the cisternogram. Cisternogram imaging, typically acquired at 0.5, 1, 2, 4, and 24 h post injection, was evaluated for the time at which radiotracer reached the basal cisterns, presence of persistent radiotracer in the lateral ventricles, time radiotracer first entered the lateral ventricles, presence of radiotracer over the cerebral convexity, and time at which radiotracer was first visualized over the cerebral convexity. MRI features of ventriculomegaly (defined as Evans’ index ≥ 0.3) and high convexity tight sulci (HCTS) were recorded. Based on the MRI features, patients were grouped according to presence or absence of DESH (ventriculomegaly and HCTS). Those without DESH were separated into groups of ventriculomegaly alone, HCTS alone, and neither ventriculomegaly nor HCTS. Cisternogram metrics were compared between MR-defined groups. Patients with DESH showed a higher frequency of radiotracer in the lateral ventricles and delayed or absent ascent over the cerebral convexity compared to those without DESH, higher frequency of ventricular radioactivity vs those with HCTS alone, and shorter time to ventricular radioactivity compared to those with ventriculomegaly alone. Patients with ventriculomegaly or HCTS alone had a higher frequency of radiotracer in the lateral ventricles and delayed ascent of radiotracer over the cerebral convexity compared to those with neither ventriculomegaly nor HCTS. These findings support DESH and the individual components of ventriculomegaly and HCTS as markers of disordered CSF dynamics.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
| | | | - Lincoln I Wurtz
- Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN 55902, USA
| | - Neill R Graff-Radford
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Christopher H Hunt
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Department of Information Technology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - David T Jones
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - John Huston Iii
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
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