Diffusion tensor imaging detects early brain microstructure changes before and after ventriculoperitoneal shunt in children with high intracranial pressure hydrocephalus

Abstract

To explore the use of diffusion tensor imaging (DTI) parameters in the quantitative assessment of early brain microstructure changes before and after ventriculoperitoneal shunt in children with high intracranial pressure hydrocephalus.Ten patients with communicating hydrocephalus (age: 2–36 months) and 14 age-/gender-matched controls (age: 2–36 months) were enrolled in this study. All patients underwent the ventriculoperitoneal shunt procedure. The imaging data were collected before and 3 months after the operation. Regions of interests (ROIs) included the white matter near the frontal horn of the lateral ventricles (FHLV), the occipital horn of the lateral ventricles (OHLV), occipital subcortical (OS) area, frontal subcortical (FS) area, and thalamus. Fractional anisotropies (FA) and apparent diffusion coefficients (ADC) of the ROIs before and after ventriculoperitoneal shunt were compared between the patients and the controls.Three months after surgery, the patients recovered from the surgery with ameliorated intracranial pressure and slight improvement of clinical intelligence scale and motor scale. Before ventriculoperitoneal shunt, the FA values (except the right FHLV) were significantly decreased and the ADC values were significantly increased in the patients with hydrocephalus, compared with the controls. After the ventriculoperitoneal shunt, the FA values in the FHLV and OHLV of the patients were similar to the controls, but the FA values in other ROIs were still significantly lower than controls. The ADC values in the FS and OS white matter areas of the patients were similar to the controls; however, the ADC values in other ROIs were still significantly higher in patients.The increase of FA and the reduction in ADC in the ROIs preceded the clinical function improvement in patients with high intracranial pressure hydrocephalus and reflected the early changes in brain tissue microstructure, such as the compression of the white matter areas in the ROIs.

Extended Combined Neonatal Treatment With Erythropoietin Plus Melatonin Prevents Posthemorrhagic Hydrocephalus of Prematurity in Rats

“…Studies using DTI in children with hydrocephalus have shown alterations in white matter microstructural integrity ( Mangano et al, 2016 ; Zhao et al, 2016 ), similar to what we have shown here in toddler-equivalent P21 vehicle-treated CAM-IVH rats. In preclinical studies, extended neonatal EPO treatment mitigated widespread DTI abnormalities in white and gray matter ( Robinson et al, 2016 , 2017 ).…”

“…Due to the challenges in obtaining reliable functional outcomes in neonates, DTI has emerged as an imaging biomarker for perinatal brain injury ( Vollmer et al, 2017 ; Hollund et al, 2018 ; Olsen et al, 2018 ). In particular, congenital hydrocephalus in children is associated with widespread DTI microstructural abnormalities ( Mangano et al, 2016 ; Zhao et al, 2016 ). To supplement the functional outcome quantified with the behavior battery, we assessed regional variation in white and gray matter microstructure ( Figures 3 , 4A ).…”

Diffusion tensor imaging in idiopathic normal pressure hydrocephalus: clinical and CSF flowmetry correlations

“…Our study has some limitations, first of all the small population, just 15 patients. This is the drawback of almost all the previous studies on this topic: Zhao et al 19 and Marumoto et al 18 reported on 10 patients, Hattori et al 13 on 18 patients and Koyama et al 11 on 20 patients. Thus, we do believe that a larger, multicentric study should be conducted to analyse better these correlations and generate a higher statistical significance.…”

“…Furthermore, we analysed areas according to the literature, such as forceps minor, anterior thalamic radiation 11,18 and frontal subcortical areas. 19 Several previous studies have demonstrated that idiopathic NPH patients exhibit lower FA values in the frontal area, but just a few studies have correlated DTI to clinical data. 11,18 To our knowledge, this is the first study comparing all DTI quantitative parameters -RD, MD, AD and FA -not only to specific clinical scores -MMSE and FAB -but also to CSF flowmetry.…”

Altered neonatal white and gray matter microstructure is associated with neurodevelopmental impairments in very preterm infants with high-grade brain injury

“…However, within the BI group, there was evidence to suggest that PHH infants had higher MD in the right thalamus, with additional differences in AD relative to cPVL and IVH infants. Prior clinical-case studies have linked hydrocephalus to DTI alterations in the thalamus (34). Thus, in preterm infants with PHH, higher thalamic MD and AD may be indicative of reduced tissue density and neuronal loss (35).…”