Article
Diffusion tensor imaging as a possible differential diagnostic marker in normal pressure hydrocephalus
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Authors
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D. Horínek
- Klinik für Neurochirurgie, Philipps-Universität, Marburg, Deutschland; Neurochirurgicka klinika, Ustredni vojenska nemocnice, Praha, Ceska Republika; International Clinical Research Centre, Brno, Ceska Republika
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I. Buksakowská
- Radiodiagnosticke oddeleni, Fakultni nemocnice Motol, Praha, Ceska Republika; International Clinical Research Centre, Brno, Ceska Republika
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T. Kincses
- Department of Neurology, University of Szeged, Hungary; International Clinical Research Centre, Brno, Ceska Republika
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V. Šulc
- International Clinical Research Centre, Brno, Ceska Republika; Neurologicka klinika, FN Motol, Ceska Republika
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N. Szabo
- Department of Neurology, University of Szeged, Hungary; International Clinical Research Centre, Brno, Ceska Republika
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J. Hort
- International Clinical Research Centre, Brno, Ceska Republika; Neurologicka klinika, FN Motol, Ceska Republika
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M. Mohapl
- Neurochirurgicka klinika, Ustredni vojenska nemocnice, Praha, Ceska Republika
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M. Vyhnálek
- International Clinical Research Centre, Brno, Ceska Republika; Neurologicka klinika, FN Motol, Ceska Republika
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C. Nimsky
- Klinik für Neurochirurgie, Philipps-Universität, Marburg, Deutschland
| Published: | June 4, 2012 |
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Outline
Text
Objective: Normal pressure hydrocephalus (NPH) is a syndrome, the etiology of which remains unknown. There is a need for a more specific diagnostics. The most frequent differential diagnosis for NPH is Alzheimer's disease (AD). Due to the possible changes of physical parameters in the periventricular white matter in NPH patients, the anisotropy of diffusion investigated by DTI imaging could be a differential diagnosis marker between those often overlapping syndromes.
Methods: We enrolled 17 patients with NPH, 14 with AD and 16 healthy controls with similar distribution of age and sex as clinical groups. All patients underwent 3T MRI examination including T2W, T1W and DTI sequence of the whole brain in axial sections (along 30 noncollinear gradient directions with b value of 1000 s/mm2, with additional five b=0 images). DTI metrics (FA, MD, L1) were evaluated by using tract-specific analysis (TBSS) and comparing the groups. In order to verify the results potentially influenced by misregistrations, we carried out a ROI analysis for distinctive WM tracts respectively.
Results: WM microstructure as evaluated by group level voxel-wise FA differences in the centre of white matter fibre bundles was significantly altered in NPH patients as compared to controls. Specifically regions of lower FA in NPH patients were found in the posterior part of the corpus callosum and in the occipital (putative optic radiation) and parietal white matter (maximal t-score=6.65 in the corpus callosum). In contrast, FA was found to be higher in NPH patients than in controls in the bilateral corona radiata, including putative cortico-spinal fibres (maximal t-score=8.47, in the left parietal white matter). Comparison between AD and NPH group showed higher FA values in the AD group in the left occipital lobe (putative optic radiation). In NPH patients, the FA was increased in the bilateral corona radiata, internal capsule on the left side and also bilaterally in the white matter anterior of the frontal horns of the lateral ventricles, consistently with ROI analysis (maximal t-score=5.56).
Conclusions: The results showed significant differences in patterns of WM degeneration between AD, NPH patients and controls. The increase of FA in the lateral periventricular white matter may reflect the compression of the white matter in NPH patients. The DTI imaging as possible specific diagnostic marker of NPH deserves further attention and re-evaluation on a larger sample of patients.
