scholarly journals Midbrain area and the hummingbird sign from brain MRI in progressive supranuclear palsy and idiopathic normal pressure hydrocephalus

2021 ◽  
Author(s):  
Johan Virhammar ◽  
Harald Blohmé ◽  
Dag Nyholm ◽  
Charalampos Georgiopoulos ◽  
David Fällmar
Keyword(s):  
Progressive Supranuclear Palsy ◽  
Normal Pressure Hydrocephalus ◽  
Brain Mri ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus

Midbrain morphology in idiopathic normal pressure hydrocephalus: A progressive supranuclear palsy mimic

2020 ◽  
Vol 141 (4) ◽  
pp. 328-334 ◽  
Author(s):  
Vasilios C. Constantinides ◽  
George P. Paraskevas ◽  
Georgios Velonakis ◽  
Panagiotis Toulas ◽  
Leonidas Stefanis ◽  
...  
Keyword(s):  
Progressive Supranuclear Palsy ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus

scholarly journals Systematic volumetric analysis predicts response to CSF drainage and outcome to shunt surgery in idiopathic normal pressure hydrocephalus

2021 ◽  
Author(s):  
Dan Wu ◽  
Abhay Moghekar ◽  
Wen Shi ◽  
Ari M. Blitz ◽  
Susumu Mori
Keyword(s):  
White Matter ◽  
Normal Pressure Hydrocephalus ◽  
Neurodegenerative Disorder ◽  
Brain Mri ◽  
Area Under The Curve ◽  
Normal Pressure ◽  
Volumetric Analysis ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Placement ◽  
Csf Drainage

Abstract Objectives Idiopathic normal pressure hydrocephalus (INPH) is a neurodegenerative disorder characterized by excess cerebrospinal fluid (CSF) in the ventricles, which can be diagnosed by invasive CSF drainage test and treated by shunt placement. Here, we aim to investigate the diagnostic and prognostic power of systematic volumetric analysis based on brain structural MRI for INPH. Methods We performed a retrospective study with a cohort of 104 probable INPH patients who underwent CSF drainage tests and another cohort of 41 INPH patients who had shunt placement. High-resolution T1-weighted images of the patients were segmented using an automated pipeline into 283 structures that are grouped into different granularity levels for volumetric analysis. Volumes at multi-granularity levels were used in a recursive feature elimination model to classify CSF drainage responders and non-responders. We then used pre-surgical brain volumes to predict Tinetti and MMSE scores after shunting, based on the least absolute shrinkage and selection operator. Results The classification accuracy of differentiating the CSF drainage responders and non-responders increased as the granularity increased. The highest diagnostic accuracy was achieved at the finest segmentation with a sensitivity/specificity/precision/accuracy of 0.89/0.91/0.84/0.90 and an area under the curve of 0.94. The predicted post-surgical neurological scores showed high correlations with the ground truth, with r = 0.80 for Tinetti and r = 0.88 for MMSE. The anatomical features that played important roles in the diagnostic and prognostic tasks were also illustrated. Conclusions We demonstrated that volumetric analysis with fine segmentation could reliably differentiate CSF drainage responders from other INPH-like patients, and it could accurately predict the neurological outcomes after shunting. Key Points • We performed a fully automated segmentation of brain MRI at multiple granularity levels for systematic volumetric analysis of idiopathic normal pressure hydrocephalus (INPH) patients. • We were able to differentiate patients that responded to CSF drainage test with an accuracy of 0.90 and area under the curve of 0.94 in a cohort of 104 probable INPH patients, as well as to predict the post-shunt gait and cognitive scores with a coefficient of 0.80 for Tinetti and 0.88 for MMSE. • Feature analysis showed the inferior lateral ventricle, bilateral hippocampus, and orbital cortex are positive indicators of CSF drainage responders, whereas the posterior deep white matter and parietal subcortical white matter were negative predictors.

Brain MRI as a predictor of CSF tap test response in patients with idiopathic normal pressure hydrocephalus

2010 ◽  
Vol 257 (10) ◽  
pp. 1675-1681 ◽  
Author(s):  
Wei-Ju Lee ◽  
Shuu-Jiun Wang ◽  
Li-Chi Hsu ◽  
Jiing-Feng Lirng ◽  
Chen-Hao Wu ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Brain Mri ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Tap Test ◽  
Test Response

scholarly journals Magnetic resonance parkinsonism indices and interpeduncular angle in idiopathic normal pressure hydrocephalus and progressive supranuclear palsy

2020 ◽  
Vol 62 (12) ◽  
pp. 1657-1665
Author(s):  
Lorenzo Ugga ◽  
Renato Cuocolo ◽  
Sirio Cocozza ◽  
Giuseppe Pontillo ◽  
Andrea Elefante ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Progressive Supranuclear Palsy ◽  
Normal Pressure Hydrocephalus ◽  
Clinical Presentation ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Healthy Controls ◽  
Intra Class Correlation ◽  
Two Populations ◽  
Intra Class Correlation Coefficient

Abstract Purpose The clinical presentation of idiopathic normal pressure hydrocephalus (iNPH) may overlap with progressive supranuclear palsy (PSP). The Magnetic Resonance Parkinsonism Index (MRPI), MRPI 2.0, and the interpeduncular angle (IPA) have been investigated to differentiate PSP from healthy controls (HC) and other parkinsonisms. We aimed to assess equivalences and differences in MRPI, MRPI 2.0, and IPA in iNPH, PSP, and HC groups. Methods We retrospectively recruited 99 subjects (30 iNPH, 32 PSP, 37 HC) from two institutions. MRI exams, acquired on either 1.5 T or 3 T scanners, included 3D T1-weighted images to measure MRPI, MRPI 2.0, and IPA. Inter- and intra-rater reliability was investigated with the intra-class correlation coefficient (ICC), and the two one-sided t tests (TOST) procedure was used to assess these markers in iNPH, PSP, and HC. Results For all the three measures, intra-rater and inter-rater ICC were excellent (range = 0.91–0.93). In the comparison of iNPH and PSP with HC, differences for MRPI and MRPI 2.0 (p < 0.01 in all cases) and no equivalence (p = 1.00 in all cases) were found at TOST. iNPH and PSP MRPI showed no difference (p = 0.06) and no equivalence (p = 0.08). MRPI 2.0 was not equivalent (p = 0.06) and not different (p = 0.09) in the same two populations. PSP and HC IPA proved equivalent (p < 0.01) while iNPH IPA was different (p < 0.01) and not equivalent (p = 0.96 and 0.82) from both PSP and HC. Conclusion MRPI and MRPI 2.0 significantly overlap in iNPH and PSP, with risk of misdiagnosis, and for this reason may not be helpful in the differential diagnosis.

Clinical Outcome and Striatal Dopaminergic Function After Shunt Surgery in Patients With Idiopathic Normal Pressure Hydrocephalus

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012064
Author(s):  
Massimiliano Todisco ◽  
Roberta Zangaglia ◽  
Brigida Minafra ◽  
Patrizia Pisano ◽  
Giuseppe Trifirò ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Rating Scales ◽  
Brain Mri ◽  
Phenotypic Expression ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Surgery ◽  
Post Surgery ◽  
Dopaminergic Dysfunction

Objective:To determine changes in clinical features and striatal dopamine reuptake transporter (DAT) density after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).Methods:Subjects with probable iNPH were assessed at baseline by means of clinical rating scales, brain MRI, and SPECT with [123I]-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane (FP-CIT). Levodopa responsiveness was also evaluated. Patients who did or did not undergo lumboperitoneal shunt were clinically followed up and repeated SPECT after 2 years.Results:We enrolled 115 iNPH patients. Of 102 subjects without significant levodopa response and no signs of atypical parkinsonism, 92 performed FP-CIT SPECT (58 also at follow-up) and 59 underwent surgery. We identified a disequilibrium subtype (phenotype 1) and a locomotor subtype (phenotype 2) of higher-level gait disorder. Gait impairment correlated with caudate DAT density in both phenotypes, whereas parkinsonian signs correlated with putamen and caudate DAT binding in patients with phenotype 2, who showed more severe symptoms and lower striatal DAT density. Gait and caudate DAT binding improved in both phenotypes after surgery (p < 0.01). Parkinsonism and putamen DAT density improved in shunted patients with phenotype 2 (p < 0.001). Conversely, gait, parkinsonian signs, and striatal DAT binding worsened in subjects who declined surgery (p < 0.01).Conclusions:This prospective interventional study highlights the pathophysiological relevance of striatal dopaminergic dysfunction in the motor phenotypic expression of iNPH. Absence of levodopa responsiveness, shunt-responsive parkinsonism, and post-surgery improvement of striatal DAT density are findings that corroborate the notion of a reversible striatal dysfunction in a subset of iNPH patients.

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