Cargando…

MRI diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus

INTRODUCTION: Core symptomatology in idiopathic normal pressure hydrocephalus (iNPH) points at dysfunction in the mesencephalon and pons indicating pathological changes in these regions, but only a few studies have addressed the issue. The aim of this study was to investigate diffusion (ADC) and per...

Descripción completa

Detalles Bibliográficos
Autores principales: Agerskov, Simon, Arvidsson, Jonathan, Ziegelitz, Doerthe, Lagerstrand, Kerstin, Starck, Göran, Björkman-Burtscher, Isabella M., Wikkelsö, Carsten, Tullberg, Mats
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544092/
https://www.ncbi.nlm.nih.gov/pubmed/33031420
http://dx.doi.org/10.1371/journal.pone.0240327
_version_ 1783591787853512704
author Agerskov, Simon
Arvidsson, Jonathan
Ziegelitz, Doerthe
Lagerstrand, Kerstin
Starck, Göran
Björkman-Burtscher, Isabella M.
Wikkelsö, Carsten
Tullberg, Mats
author_facet Agerskov, Simon
Arvidsson, Jonathan
Ziegelitz, Doerthe
Lagerstrand, Kerstin
Starck, Göran
Björkman-Burtscher, Isabella M.
Wikkelsö, Carsten
Tullberg, Mats
author_sort Agerskov, Simon
collection PubMed
description INTRODUCTION: Core symptomatology in idiopathic normal pressure hydrocephalus (iNPH) points at dysfunction in the mesencephalon and pons indicating pathological changes in these regions, but only a few studies have addressed the issue. The aim of this study was to investigate diffusion (ADC) and perfusion patterns pre- and postoperatively in these areas in iNPH. METHODS: Twenty iNPH patients and 15 healthy controls were included. Patients underwent a clinical examination and brain MRI pre- and 3–6 months postoperatively. The MRI-scan included diffusion and dynamic susceptibility contrast perfusion weighted sequences. Regions of interest in the mesencephalon and pons were drawn on a FLAIR sequence and co-registered to ADC maps and perfusion data. RESULTS: There were no significant differences in pre or postoperative ADC compared to the control group, however postoperative ADC increased by 10% (p = 0.026) in the mesencephalon and 6% (p = 0.016) in the pons in all patients and also in the subgroup of shunt responders by 11% (p = 0.021) and 4% (p = 0.020), respectively. Preoperative relative cerebral blood flow (rCBF) was similar in iNPH patients and controls. Postoperatively, rCBF increased in shunt responders by 6% (p = 0.02) in the mesencephalon and 11% (p = 0.004) in the pons. This increase correlated with the degree of clinical improvement (r(s) = 0.80, p = 0.031 and r(s) = 0.66, p = 0.021, respectively). CONCLUSION: The postoperative increase in ADC and the correlation between postoperative increase in rCBF and clinical improvement in the mesencephalon and pons shown in this study point at an involvement of these areas in the core pathophysiology and its reversibility in iNPH.
format Online
Article
Text
id pubmed-7544092
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-75440922020-10-19 MRI diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus Agerskov, Simon Arvidsson, Jonathan Ziegelitz, Doerthe Lagerstrand, Kerstin Starck, Göran Björkman-Burtscher, Isabella M. Wikkelsö, Carsten Tullberg, Mats PLoS One Research Article INTRODUCTION: Core symptomatology in idiopathic normal pressure hydrocephalus (iNPH) points at dysfunction in the mesencephalon and pons indicating pathological changes in these regions, but only a few studies have addressed the issue. The aim of this study was to investigate diffusion (ADC) and perfusion patterns pre- and postoperatively in these areas in iNPH. METHODS: Twenty iNPH patients and 15 healthy controls were included. Patients underwent a clinical examination and brain MRI pre- and 3–6 months postoperatively. The MRI-scan included diffusion and dynamic susceptibility contrast perfusion weighted sequences. Regions of interest in the mesencephalon and pons were drawn on a FLAIR sequence and co-registered to ADC maps and perfusion data. RESULTS: There were no significant differences in pre or postoperative ADC compared to the control group, however postoperative ADC increased by 10% (p = 0.026) in the mesencephalon and 6% (p = 0.016) in the pons in all patients and also in the subgroup of shunt responders by 11% (p = 0.021) and 4% (p = 0.020), respectively. Preoperative relative cerebral blood flow (rCBF) was similar in iNPH patients and controls. Postoperatively, rCBF increased in shunt responders by 6% (p = 0.02) in the mesencephalon and 11% (p = 0.004) in the pons. This increase correlated with the degree of clinical improvement (r(s) = 0.80, p = 0.031 and r(s) = 0.66, p = 0.021, respectively). CONCLUSION: The postoperative increase in ADC and the correlation between postoperative increase in rCBF and clinical improvement in the mesencephalon and pons shown in this study point at an involvement of these areas in the core pathophysiology and its reversibility in iNPH. Public Library of Science 2020-10-08 /pmc/articles/PMC7544092/ /pubmed/33031420 http://dx.doi.org/10.1371/journal.pone.0240327 Text en © 2020 Agerskov et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Agerskov, Simon
Arvidsson, Jonathan
Ziegelitz, Doerthe
Lagerstrand, Kerstin
Starck, Göran
Björkman-Burtscher, Isabella M.
Wikkelsö, Carsten
Tullberg, Mats
MRI diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus
title MRI diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus
title_full MRI diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus
title_fullStr MRI diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus
title_full_unstemmed MRI diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus
title_short MRI diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus
title_sort mri diffusion and perfusion alterations in the mesencephalon and pons as markers of disease and symptom reversibility in idiopathic normal pressure hydrocephalus
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544092/
https://www.ncbi.nlm.nih.gov/pubmed/33031420
http://dx.doi.org/10.1371/journal.pone.0240327
work_keys_str_mv AT agerskovsimon mridiffusionandperfusionalterationsinthemesencephalonandponsasmarkersofdiseaseandsymptomreversibilityinidiopathicnormalpressurehydrocephalus
AT arvidssonjonathan mridiffusionandperfusionalterationsinthemesencephalonandponsasmarkersofdiseaseandsymptomreversibilityinidiopathicnormalpressurehydrocephalus
AT ziegelitzdoerthe mridiffusionandperfusionalterationsinthemesencephalonandponsasmarkersofdiseaseandsymptomreversibilityinidiopathicnormalpressurehydrocephalus
AT lagerstrandkerstin mridiffusionandperfusionalterationsinthemesencephalonandponsasmarkersofdiseaseandsymptomreversibilityinidiopathicnormalpressurehydrocephalus
AT starckgoran mridiffusionandperfusionalterationsinthemesencephalonandponsasmarkersofdiseaseandsymptomreversibilityinidiopathicnormalpressurehydrocephalus
AT bjorkmanburtscherisabellam mridiffusionandperfusionalterationsinthemesencephalonandponsasmarkersofdiseaseandsymptomreversibilityinidiopathicnormalpressurehydrocephalus
AT wikkelsocarsten mridiffusionandperfusionalterationsinthemesencephalonandponsasmarkersofdiseaseandsymptomreversibilityinidiopathicnormalpressurehydrocephalus
AT tullbergmats mridiffusionandperfusionalterationsinthemesencephalonandponsasmarkersofdiseaseandsymptomreversibilityinidiopathicnormalpressurehydrocephalus