Diffusion Tensor Imaging Reveals Supplementary Lesions to Frontal White Matter in Idiopathic Normal Pressure Hydrocephalus

Abstract BACKGROUND: Idiopathic normal-pressure hydrocephalus (INPH) is associated with white matter lesions, but the extent and severity of the lesions do not cohere with symptoms or improvement after shunting, implying the presence of further, yet undisclosed, injuries to white matter in INPH. OBJECTIVE: To apply diffusion tensor imaging (DTI) to explore white matter lesions in patients with INPH before and after drainage of cerebrospinal fluid (CSF). METHODS: Eighteen patients and 10 controls were included. DTI was performed in a 1.5T MRI scanner before and after 3-day drainage of 400 mL of CSF. Regions of interest included corpus callosum, capsula interna, frontal and lateral periventricular white matter, and centrum semiovale. White matter integrity was quantified by assessing fractional anisotropies (FA) and apparent diffusion coefficients (ADC), comparing them between patients and controls and between patients before and after drainage. The significance level corresponded to .05 (Bonferroni corrected). RESULTS: Decreased FA in patients was found in 3 regions (P < .002, P < .001, and P < .001) in anterior frontal white matter, whereas elevated ADC was found in genu corpus callosum (P < .001) and areas of centrum semiovale associated with the precentral gyri (P < .002). Diffusion patterns in these areas did not change after drainage. CONCLUSION: DTI reveals subtle injuries—interpreted as axonal loss and gliosis—to anterior frontal white matter where high-order motor systems between frontal cortex and basal ganglia travel, further supporting the notion that motor symptoms in INPH are caused by a chronic ischemia to the neuronal systems involved in the planning processes of movements.

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242 – Voxel-based study of diffusion tensor imaging in bipolar i disorder: Exploratory analysis and focus on frontal white matter and corpus callosum

Schizophrenia Research ◽

10.1016/j.schres.2007.12.309 ◽

2008 ◽

Vol 98 ◽

pp. 133

Author(s):

M.V. Zanetti ◽

M.P. Jackowski ◽

S. Hassel ◽

F.L.S. Duran ◽

J.R.C. Almeida ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Corpus Callosum ◽

Diffusion Tensor ◽

Exploratory Analysis ◽

Bipolar I Disorder ◽

Frontal White Matter

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White matter involvement in idiopathic normal pressure hydrocephalus: a voxel-based diffusion tensor imaging study

Journal of Neurology ◽

10.1007/s00415-011-6038-5 ◽

2011 ◽

Vol 258 (11) ◽

pp. 1949-1957 ◽

Cited By ~ 52

Author(s):

Shigenori Kanno ◽

Nobuhito Abe ◽

Makoto Saito ◽

Masahito Takagi ◽

Yoshiyuki Nishio ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Normal Pressure Hydrocephalus ◽

Diffusion Tensor ◽

Imaging Study ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Diffusion Tensor Imaging Study

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Diffusion Tensor Imaging, White Matter Lesions, the Corpus Callosum, and Gait in the Elderly

Stroke ◽

10.1161/strokeaha.109.564765 ◽

2009 ◽

Vol 40 (12) ◽

pp. 3816-3820 ◽

Cited By ~ 70

Author(s):

Refeeque A. Bhadelia ◽

Lori Lyn Price ◽

Kurtis L. Tedesco ◽

Tammy Scott ◽

Wei Qiao Qiu ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Corpus Callosum ◽

Diffusion Tensor ◽

White Matter Lesions ◽

The Elderly

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White Matter Characteristics of Cognitive Impairment in Tap-Test Positive Idiopathic Normal Pressure Hydrocephalus: A Diffusion Tensor Tract-Based Spatial Study

Frontiers in Neuroscience ◽

10.3389/fnins.2021.774638 ◽

2021 ◽

Vol 15 ◽

Author(s):

Yufeng Tang ◽

Xiaoqin Yuan ◽

Jinfeng Duan ◽

Xianwen Zhang ◽

Jiao Chen ◽

...

Keyword(s):

Cognitive Impairment ◽

White Matter ◽

Corpus Callosum ◽

Normal Pressure Hydrocephalus ◽

Diffusion Tensor ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Cingulate Gyrus ◽

Tap Test ◽

Cognitive Improvement

The present study was designed to systemically evaluate changes in the diffusion tensor imaging (DTI)-derived parameters of iNPH (idiopathic normal pressure hydrocephalus) patients with different responses to the tap test (TT), and to correlate cognitive impairment with white matter (WM) degeneration. This study included 22 iNPH patients and 14 healthy controls with structural magnetic resonance imaging (MRI) and DTI scanning. DTI was used to explore the differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) for all participants. DTI parameters were evaluated using an ROI (region of interest)-based and tract-based spatial statistics (TBSS) approach. Neuropsychological assessments and the idiopathic normal pressure hydrocephalus grading scoring scale (iNPHGS) were performed. Compared to the TT non-responders, the TT responders group had significantly lower FA values in the corpus callosum, cingulum cingulate gyrus, superior longitudinal fasciculus, and lower AD values in the right cingulum cingulate gyrus and the left posterior thalamic radiation. Besides, the MD values were significantly increased in the corpus callosum, left anterior corona radiata, and the RD values in the corpus callosum and cingulum cingulate gyrus. In addition, the cognitive improvement was negatively correlated with FA of the corpus callosum, cingulum cingulate gyrus, and MD values of the genu of corpus callosum. While, the cognitive improvement was positively related to the AD of the cingulum cingulate gyrus, superior longitudinal, and RD values of the corpus callosum, cingulum cingulate gyrus and uncinate fasciculus. The ROI specific WM lesions in iNPH patients are the underlying basis for cognitive impairment.

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Indication of Thalamo-Cortical Circuit Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Diffusion Tensor Imaging Study

Scientific Reports ◽

10.1038/s41598-020-63238-7 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Andreas Eleftheriou ◽

Ida Blystad ◽

Anders Tisell ◽

Johan Gasslander ◽

Fredrik Lundin

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Normal Pressure Hydrocephalus ◽

Diffusion Tensor ◽

Imaging Study ◽

Clinical Work ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Periventricular White Matter ◽

Cortical Circuit

AbstractIdiopathic normal pressure hydrocephalus (iNPH) is a disorder with unclear pathophysiology. The diagnosis of iNPH is challenging due to its radiological similarity with other neurodegenerative diseases and ischemic subcortical white matter changes. By using Diffusion Tensor Imaging (DTI) we explored differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in iNPH patients (before and after a shunt surgery) and healthy individuals (HI) and we correlated the clinical results with DTI parameters. Thirteen consecutive iNPH-patients underwent a pre- and post-operative clinical work-up: 10 m walk time (w10mt) steps (w10ms), TUG-time (TUGt) and steps (TUGs); for cognitive function MMSE. Nine HI were included. DTI was performed before and 3 months after surgery, HI underwent DTI once. DTI differences analyzed by manually placing 12 regions-of-interest. In patients motor and balance function improved significantly after surgery (p = 0.01, p = 0.025). Higher nearly significant FA values found in the patients vs HI pre-operatively in the thalamus (p = 0.07) accompanied by an almost significant lower ADC (p = 0.08). Significantly FA and ADC-values were found between patients and HI in FWM (p = 0.02, p = 0.001) and almost significant (p = 0.057) pre- vs postoperatively. Postoperatively we found a trend towards the HIs FA values and a strong significant negative correlation between FA changes vs. gait results in the FWM (r = −0.7, p = 0.008). Our study gives a clear indication of an ongoing pathological process in the periventricular white matter, especially in the thalamus and in the frontal white matter supporting the hypothesis of a shunt reversible thalamo-cortical circuit dysfunction in iNPH.

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