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Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study.
J Neurosurg. 2018 12 01; 129(6):1611-1622.JN

Abstract

OBJECTIVE

The object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.

METHODS

Patients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5% false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.

RESULTS

Twenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.

CONCLUSIONS

The study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus.

Authors+Show Affiliations

1Department of Radiology, Gruss Magnetic Resonance Research Center, and.1Department of Radiology, Gruss Magnetic Resonance Research Center, and.Departments of2Epidemiology and Population Health.3Department of Neurological Surgery, Children's Hospital at Montefiore; and.3Department of Neurological Surgery, Children's Hospital at Montefiore; and.3Department of Neurological Surgery, Children's Hospital at Montefiore; and.1Department of Radiology, Gruss Magnetic Resonance Research Center, and. 5Department of Radiology, Montefiore Medical Center, Bronx, New York.1Department of Radiology, Gruss Magnetic Resonance Research Center, and. 4Neuroscience. 5Department of Radiology, Montefiore Medical Center, Bronx, New York. 6Psychiatry and Behavioral Sciences, and.1Department of Radiology, Gruss Magnetic Resonance Research Center, and. 7Physiology and Biophysics, Albert Einstein College of Medicine.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29350598

Citation

Tan, Kristy, et al. "Diffusion Tensor Imaging and Ventricle Volume Quantification in Patients With Chronic Shunt-treated Hydrocephalus: a Matched Case-control Study." Journal of Neurosurgery, vol. 129, no. 6, 2018, pp. 1611-1622.
Tan K, Meiri A, Mowrey WB, et al. Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study. J Neurosurg. 2018;129(6):1611-1622.
Tan, K., Meiri, A., Mowrey, W. B., Abbott, R., Goodrich, J. T., Sandler, A. L., Suri, A. K., Lipton, M. L., & Wagshul, M. E. (2018). Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study. Journal of Neurosurgery, 129(6), 1611-1622. https://doi.org/10.3171/2017.6.JNS162784
Tan K, et al. Diffusion Tensor Imaging and Ventricle Volume Quantification in Patients With Chronic Shunt-treated Hydrocephalus: a Matched Case-control Study. J Neurosurg. 2018 12 1;129(6):1611-1622. PubMed PMID: 29350598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study. AU - Tan,Kristy, AU - Meiri,Avital, AU - Mowrey,Wenzhu B, AU - Abbott,Rick, AU - Goodrich,James T, AU - Sandler,Adam L, AU - Suri,Asif K, AU - Lipton,Michael L, AU - Wagshul,Mark E, PY - 2016/11/08/received PY - 2017/06/19/accepted PY - 2018/1/20/pubmed PY - 2019/10/16/medline PY - 2018/1/20/entrez KW - AD = axial diffusivity KW - ALIC = anterior limb of internal capsule KW - CGC = cingulate gyrus component of the cingulum KW - CGH = hippocampal component of the cingulum KW - DTI = diffusion tensor imaging KW - FA = fractional anisotropy KW - FDR = false discovery rate KW - FOHR = frontal occipital horn ratio KW - HDI = Headache Disability Inventory KW - HOQ = Hydrocephalus Outcome Questionnaire KW - ICP = intracranial pressure KW - MD = mean diffusivity KW - NPH = normal pressure hydrocephalus KW - PLIC = posterior limb of internal capsule KW - PVWM = periventricular white matter KW - QoL = quality of life KW - RD = radial diffusivity KW - ROI = region of interest KW - SVS = slit ventricle syndrome KW - TBSS = tract-based spatial statistics KW - chronic shunting KW - diagnostic technique KW - diffusion tensor imaging KW - gCC = genu of corpus callosum KW - headache KW - pediatric hydrocephalus KW - quality of life KW - sCC = splenium of corpus callosum KW - tract-based spatial statistics SP - 1611 EP - 1622 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 129 IS - 6 N2 - OBJECTIVEThe object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.METHODSPatients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5% false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.RESULTSTwenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.CONCLUSIONSThe study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/29350598/Diffusion_tensor_imaging_and_ventricle_volume_quantification_in_patients_with_chronic_shunt_treated_hydrocephalus:_a_matched_case_control_study_ L2 - https://thejns.org/doi/10.3171/2017.6.JNS162784 DB - PRIME DP - Unbound Medicine ER -