Difference in white matter microstructure in differential diagnosis of normal pressure hydrocephalus and Alzheimer's disease

Hořínek, Daniel; Štěpán-Buksakowska, Irena; Szabó, Nikoletta; Erickson, Bradley J.; Tóth, Eszter; Šulc, Vlastimil; Beneš, Vladimı́r; Vrána, J.; Hort, Jakub; Nimsky, Christopher; Mohapl, M; Roček, Miloslav; Vécsei, László; Kincses, Zsigmond Tamás

doi:10.1016/j.clineuro.2015.11.010

Cited by 19 publications

(19 citation statements)

References 40 publications

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“…Moreover, P value of RD was higher than that of AD (P = 0.049 vs. < 0.001). This result matched the findings of previous papers [11, 12]. Interestingly, the piNPH group showed the same tendency as the iNPH group.…”

Section: Discussionsupporting

confidence: 92%

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Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers

Yokota

Vijayasarathi

Cekić

et al. 2019

Current Gerontology and Geriatrics Research

110

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Purpose. To investigate the pathological change of the glymphatic system in idiopathic normal pressure hydrocephalus (iNPH) using diffusion tensor imaging (DTI) analysis. Materials and Methods. 24 right-handed patients were referred to our hydrocephalus clinic for assessment of ventriculomegaly and gait impairment. 12 of 24 were diagnosed as pseudo-iNPH (piNPH) based on assessment by a neurologist. Diffusivity maps in the direction of the x-axis (right-to-left) (Dx), y-axis (anterior-to-posterior) (Dy), and z-axis (inferior-to-superior) (Dz) were computed. The diffusion map was coregistered to International Consortium for Brain Mapping (ICBM) DTI-81 atlas. The analysis along the perivascular space (ALPS) index was defined as mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where Dxpro and Dxasc are Dx values in the projection and association fiber areas, respectively. Evans index and callosal angle were also assessed on each case. Results. ALPS indexes of the control, piNPH, and iNPH cases were 1.18 ± 0.08, 1.08 ± 0.03, and 0.94 ± 0.06, respectively, and there were significant differences among the groups (control vs. piNPH, P = 0.003; control vs. iNPH P < 0.001; piNPH vs. iNPH, P < 0.001). Area under curve (AUC) was 0.92, 1.00, and 1.00 on control vs. piNPH, control vs. iNPH, and piNPH vs. iNPH on ROC analysis. Between piNPH and NPH, ALPS index has higher diagnostic performance than Evans index and callosal angle (AUC = 1.00 vs. 0.84, P = 0.028; AUC = 1.00 vs. 0.74, P = 0.016). Conclusion. Atlas-based ALPS index using the DTI method differentiated among iNPH, piNPH, and controls clearly.

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Section: Discussionsupporting

confidence: 92%

“…To evaluate the accuracy of coregistration to ICBM DTI-81 Atlas, FA, MD, AD, and RD of the left projection fiber area were calculated. These values have been assessed in several prior studies [11, 12]. Manual and atlas-based ALPS index were compared with box-plot and paired t-test.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers

Yokota

Vijayasarathi

Cekić

et al. 2019

Current Gerontology and Geriatrics Research

110

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“…Several researchers reported that white matter alterations in NPH include not only the reduction of FA, but also the alteration of mean diffusivity (MD) and radial diffusivity (RD) (Hattingen et al, 2010 ; Kanno et al, 2011 ). In addition, a recent study by Horinek et al demonstrated reduced FA in the corpus callosum and increased FA, MD, and RD in the cortico-fugal fibers in NPH patients (Horinek et al, 2016 ). It is possible that the alteration of interhemispheric FC in the iNPH patients shown here is founded on the structural changes of the white matter indexed by those diffusion measures.…”

Section: Discussionmentioning

confidence: 98%

Interhemispheric Resting-State Functional Connectivity Predicts Severity of Idiopathic Normal Pressure Hydrocephalus

et al. 2017

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Idiopathic normal pressure hydrocephalus (iNPH) is characterized by a clinical triad (gait disturbance, dementia, and urinary incontinence), and by radiological findings of enlarged ventricles reflecting disturbance of central spinal fluid circulation. A diagnosis of iNPH is sometimes challenging, and the pathophysiological mechanisms underlying the clinical symptoms of iNPH remain largely unknown. Here, we used an emerging MRI technique, resting-state functional connectivity MRI (rsfcMRI), to develop a subsidiary diagnostic technique and to explore the underlying pathophysiological mechanisms of iNPH. rsfcMRI data were obtained from 11 patients with iNPH and 11 age-matched healthy volunteers, yielding rsfcMRI-derived functional connectivity (FC) from both groups. A linear support vector machine classifier was trained to distinguish the patterns of FCs of the patients with iNPH from those of the healthy volunteers. After dimensional reduction, the support vector machine successfully classified the two groups with an accuracy of 80%. Moreover, we found that rsfcMRI-derived FC carried information to predict the severity of the triad in iNPH. FCs relevant to the classification of severity were mainly based on interhemispheric connectivity, suggesting that disruption of the corpus callosum fibers due to ventricular enlargement may explain the triad of iNPH. The present results support the usefulness of rsfcMRI as a tool to understand pathophysiology of iNPH, and also to help with its clinical diagnosis.

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“…264 DTI is now being studied to further elucidate the role of WM disease in NPH, 265 and initial results suggest that it may assist with differential diagnosis. [266][267][268][269] Other advanced MRI techniques have been proposed together with DTI to go beyond the limits of structural imaging to help diagnose iNPH more accurately. New CSF quantification techniques such as Time-SLIP sequences are being investigated to gain better insight into CSF flow behavior in NPH.…”

Section: Idiopathic Normal Pressure Hydrocephalusmentioning

confidence: 99%

Neuroimaging in Dementia

et al. 2017

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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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Difference in white matter microstructure in differential diagnosis of normal pressure hydrocephalus and Alzheimer's disease

Cited by 19 publications

References 40 publications

Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers

Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers

Interhemispheric Resting-State Functional Connectivity Predicts Severity of Idiopathic Normal Pressure Hydrocephalus

Neuroimaging in Dementia

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