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AJNR - American Journal of Neuroradiology

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Proton Chemical Shift Imaging in Normal Pressure Hydrocephalus

Osamu Kizu^a, Kei Yamada^a and Tsunehiko Nishimura^a

^a From the Department of Radiology, Kyoto, Japan.

View larger version (103K): [in a new window]   FIG 1. Proton MR spectra (TR/TE, 2000/135) in the patient with NPH. Upper left, axial T1-weighted MR image of the same patient. A box outlines volume of interest, which includes the bodies of lateral ventricles in the hemisphere. Lower left corner shows spectra from the body of the left lateral ventricle and surrounding parenchyma. The spectrum from the voxel of the parenchyma (black arrow) shows normal spectral pattern (upper right). The spectrum from the voxel in the body of left lateral ventricle (white arrow) shows the lactate peak (lower right). NAA, Cho, and Cr peaks also are observed, suggesting that this intraventricular voxel contains periventricular brain tissue

View larger version (20K): [in a new window]   FIG 2. Proton MR spectra (TR/TE, 2000/135) in two patients with NPH. The spectra obtained from periventricular regions (upper row) with the intraventricular spectra (lower row) are shown. Apparent inverted doublet peaks at 1.3 ppm are observed in the intraventricular spectrum of one case (left side) and can be recognized as lactate peaks. In the other case (right side), good qualities of lactate peaks are seen compared with the peaks from the periventricular region in the upper row

View larger version (86K): [in a new window]   FIG 3. Proton MR spectra (TR/TE, 2000/135) before and after continuous spinal drainage in the lateral ventricle of a patient with NPH. The spectra were obtained from a intraventricular voxel (black arrow in VOI). Before treatment, lactate peaks are observed as inverted doublet peaks at 1.3 ppm from the intraventricular voxel of NPH (upper middle). Cho, Cr, and NAA peaks suggest partial volume artifact from periventricular brain tissue. A metabolic image of lactate (upper right) before treatment shows that lactate is confined to the lateral ventricles and surroundings. After treatment, lactate is not observed clearly (lower right). The reduced CBF (upper left) returned to normal after continuous spinal drainage (lower left) at SPECT