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Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers.
Curr Gerontol Geriatr Res 2019; 2019:5675014CG

Abstract

Purpose

To investigate the pathological change of the glymphatic system in idiopathic normal pressure hydrocephalus (iNPH) using diffusion tensor imaging (DTI) analysis.

Materials and Methods

24 right-handed patients were referred to our hydrocephalus clinic for assessment of ventriculomegaly and gait impairment. 12 of 24 were diagnosed as pseudo-iNPH (piNPH) based on assessment by a neurologist. Diffusivity maps in the direction of the x-axis (right-to-left) (Dx), y-axis (anterior-to-posterior) (Dy), and z-axis (inferior-to-superior) (Dz) were computed. The diffusion map was coregistered to International Consortium for Brain Mapping (ICBM) DTI-81 atlas. The analysis along the perivascular space (ALPS) index was defined as mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where Dxpro and Dxasc are Dx values in the projection and association fiber areas, respectively. Evans index and callosal angle were also assessed on each case.

Results

ALPS indexes of the control, piNPH, and iNPH cases were 1.18 ± 0.08, 1.08 ± 0.03, and 0.94 ± 0.06, respectively, and there were significant differences among the groups (control vs. piNPH, P = 0.003; control vs. iNPH P < 0.001; piNPH vs. iNPH, P < 0.001). Area under curve (AUC) was 0.92, 1.00, and 1.00 on control vs. piNPH, control vs. iNPH, and piNPH vs. iNPH on ROC analysis. Between piNPH and NPH, ALPS index has higher diagnostic performance than Evans index and callosal angle (AUC = 1.00 vs. 0.84, P = 0.028; AUC = 1.00 vs. 0.74, P = 0.016).

Conclusion

Atlas-based ALPS index using the DTI method differentiated among iNPH, piNPH, and controls clearly.

Authors+Show Affiliations

Chiba University, Department of Radiology, Chiba, Japan.UCLA Department of Radiological Sciences, Los Angeles, CA, USA.UCLA Department of Radiological Sciences, Los Angeles, CA, USA.Toho University, Department of Neurosurgery, Ota, Tokyo, Japan.UCLA Department of Radiological Sciences, Los Angeles, CA, USA.UCLA Department of Neurology, Los Angeles, CA, USA.UCLA Department of Neurosurgery, Los Angeles, CA, USA.UCLA Department of Radiological Sciences, Los Angeles, CA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31320896

Citation

Yokota, Hajime, et al. "Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers." Current Gerontology and Geriatrics Research, vol. 2019, 2019, p. 5675014.
Yokota H, Vijayasarathi A, Cekic M, et al. Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers. Curr Gerontol Geriatr Res. 2019;2019:5675014.
Yokota, H., Vijayasarathi, A., Cekic, M., Hirata, Y., Linetsky, M., Ho, M., ... Salamon, N. (2019). Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers. Current Gerontology and Geriatrics Research, 2019, p. 5675014. doi:10.1155/2019/5675014.
Yokota H, et al. Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers. Curr Gerontol Geriatr Res. 2019;2019:5675014. PubMed PMID: 31320896.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers. AU - Yokota,Hajime, AU - Vijayasarathi,Arvind, AU - Cekic,Milos, AU - Hirata,Yoko, AU - Linetsky,Michael, AU - Ho,Michael, AU - Kim,Won, AU - Salamon,Noriko, Y1 - 2019/06/20/ PY - 2018/12/20/received PY - 2019/05/22/revised PY - 2019/06/04/accepted PY - 2019/7/20/entrez PY - 2019/7/20/pubmed PY - 2019/7/20/medline SP - 5675014 EP - 5675014 JF - Current gerontology and geriatrics research JO - Curr Gerontol Geriatr Res VL - 2019 N2 - Purpose: To investigate the pathological change of the glymphatic system in idiopathic normal pressure hydrocephalus (iNPH) using diffusion tensor imaging (DTI) analysis. Materials and Methods: 24 right-handed patients were referred to our hydrocephalus clinic for assessment of ventriculomegaly and gait impairment. 12 of 24 were diagnosed as pseudo-iNPH (piNPH) based on assessment by a neurologist. Diffusivity maps in the direction of the x-axis (right-to-left) (Dx), y-axis (anterior-to-posterior) (Dy), and z-axis (inferior-to-superior) (Dz) were computed. The diffusion map was coregistered to International Consortium for Brain Mapping (ICBM) DTI-81 atlas. The analysis along the perivascular space (ALPS) index was defined as mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where Dxpro and Dxasc are Dx values in the projection and association fiber areas, respectively. Evans index and callosal angle were also assessed on each case. Results: ALPS indexes of the control, piNPH, and iNPH cases were 1.18 ± 0.08, 1.08 ± 0.03, and 0.94 ± 0.06, respectively, and there were significant differences among the groups (control vs. piNPH, P = 0.003; control vs. iNPH P < 0.001; piNPH vs. iNPH, P < 0.001). Area under curve (AUC) was 0.92, 1.00, and 1.00 on control vs. piNPH, control vs. iNPH, and piNPH vs. iNPH on ROC analysis. Between piNPH and NPH, ALPS index has higher diagnostic performance than Evans index and callosal angle (AUC = 1.00 vs. 0.84, P = 0.028; AUC = 1.00 vs. 0.74, P = 0.016). Conclusion: Atlas-based ALPS index using the DTI method differentiated among iNPH, piNPH, and controls clearly. SN - 1687-7063 UR - https://www.unboundmedicine.com/medline/citation/31320896/Diagnostic_Performance_of_Glymphatic_System_Evaluation_Using_Diffusion_Tensor_Imaging_in_Idiopathic_Normal_Pressure_Hydrocephalus_and_Mimickers L2 - https://dx.doi.org/10.1155/2019/5675014 DB - PRIME DP - Unbound Medicine ER -