Abstract
Idiopathic 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.
Highlights
Idiopathic normal pressure hydrocephalus is a disorder with unclear pathophysiology
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 thalamocortical circuit dysfunction in Idiopathic normal pressure hydrocephalus (iNPH)
Our study provides a clear indication of an ongoing pathological process in the periventricular white matter, especially in the thalamus and in the frontal white matter in iNPH patients, and shows that a shunt operation can partially reverse this process
Summary
Idiopathic normal pressure hydrocephalus (iNPH) is a disorder with unclear pathophysiology. 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. Idiopathic normal pressure hydrocephalus (iNPH) is a disorder that features disturbance of gait and balance, cognitive decline and urinary incontinence caused by impaired turnover of cerebrospinal fluid (CSF)[1]. The combination of 2D diffusion-weighted images, including diagonal elements, in a 3D diffusion assessment creates a high-resolution MR technique that can reveal the integrity of periventricular white matter changes[12]. The primary aim of this study was to identify differences in DTI parameters (ADC and FA) in patients with iNPH, both before and after shunt surgery, as well as in healthy individuals (HIs). The secondary aim was to determine whether there was any correlation between clinical symptoms and DTI parameters
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