ABSTRACT
Background and Purpose
In idiopathic normal pressure hydrocephalus (iNPH) patients, cerebrospinal fluid (CSF) flow is typically evaluated with a cardiac-gated two-dimensional (2D) phase-contrast (PC) MRI through the cerebral aqueduct. This approach is limited by the evaluation of a single location and does not account for respiration effects on flow. In this study, we quantified the cardiac and respiratory contributions to CSF movement at multiple intracranial locations using a real-time 2D PC-MRI and evaluated the diagnostic value of CSF dynamics biomarkers in classifying iNPH patients.
Methods
This study included 37 participants: 16 iNPH, 10 Alzheimer’s disease (AD), and 11 cognitively unimpaired (CU) controls. Anatomical and real-time (non-gated) PC images were acquired in a 3T Philips scanner. CSF flow was assessed at the foramen magnum, fourth ventricle, Sylvian fissure, lateral ventricle, and cerebral aqueduct. We calculated three CSF dynamics biomarkers: mean velocity amplitude, cardiac signal power, and respiratory signal power. Biomarkers from each location were evaluated for classifying iNPH versus AD and CU using support vector machine (SVM). A p-value of 0.05 or less was considered statistically significant.
Results
The velocity amplitude and cardiac signal power were significantly reduced in iNPH compared to CU (p < 0.005) and AD (p < 0.05) at the lateral ventricle. The SVM model using biomarkers from the lateral ventricle performed significantly better at classifying iNPH than the other locations in terms of accuracy (p < 0.005) and diagnostic odds ratio (p < 0.05).
Conclusion
Evaluation of CSF movement beyond the cerebral aqueduct may aid in identifying patients with and understanding the pathophysiology of iNPH.
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This post is Copyright: Pragalv Karki,
Matthew C. Murphy,
Sandeep Ganji,
Jeffrey L. Gunter,
Jonathan Graff‐Radford,
David T. Jones,
Hugo Botha,
Jeremy K. Cutsforth‐Gregory,
Benjamin D. Elder,
Clifford R. Jack Jr.,
John Huston III,
Petrice M. Cogswell | December 31, 2024
Wiley: Journal of Neuroimaging: Table of Contents