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Research ArticleADULT BRAIN

Comparison of CSF Distribution between Idiopathic Normal Pressure Hydrocephalus and Alzheimer Disease

S. Yamada, M. Ishikawa and K. Yamamoto
American Journal of Neuroradiology July 2016, 37 (7) 1249-1255; DOI: https://doi.org/10.3174/ajnr.A4695
S. Yamada
aFrom the Normal Pressure Hydrocephalus Center (S.Y., M.I.)
bDepartment of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.
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M. Ishikawa
aFrom the Normal Pressure Hydrocephalus Center (S.Y., M.I.)
bDepartment of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.
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K. Yamamoto
bDepartment of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.
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  • Fig 1.
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    Fig 1.

    Maximum widths of the lateral ventricles and brain substances just above the lateral ventricles. The figures show the multiplanar reconstruction images on the T2-weighted 3D SPACE sequence. The crosses of the blue and yellow lines on the left figures indicate the points of the anterior commissure (upper) and posterior commissure (lower), and the right figures show the coronal planes at the blue lines of the left figures.

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    Fig 2.

    Scatterplots and receiver operating characteristic curves for the differential diagnosis of idiopathic normal pressure hydrocephalus and Alzheimer disease. The left upper diagram (A) shows the scatterplot and linear regression for the correlation between the BVR at the anterior level (x-axis) and those at the posterior commissure level (y-axis). The right upper diagram (B) shows the scatterplot of the 3D volumetric convexity subarachnoid space to ventricle ratio-1 (CVR-1) and CVR-2. The purple circle indicates iNPH, the purple triangle indicates iNPH concurrent with Alzheimer disease, the open red triangle indicates AD, and the open red circle indicates control. The lower diagram shows the receiver operating characteristic graph curves of BVR (left, C), CVR-1, and CVR-2 (right, D) for the differential diagnosis of iNPH or iNPH with AD from AD or controls. The x-axis shows specificity, and the y-axis shows sensitivity. The black marks indicate the point of the maximum area under the receiver operating characteristic curve and optimal thresholds (sensitivity and specificity). The maximum areas under the receiver operating characteristic curves for each comparison are displayed in the lower graph.

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    Fig 3.

    Mean volumes of the total ventricle and total subarachnoid space. The mean volumes of the total ventricle are displayed in a downward direction (dotted pattern). The mean volumes of the total subarachnoid spaces are displayed after division of the upper (vertical striped pattern) and lower parts (wave pattern) in a horizontal section on the anterior/posterior commissure plane at the level of the junction point of the vein of Galen and straight sinus.

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    Fig 4.

    The mean volumes of the segmented parts of the subarachnoid spaces. The vertical-striped pattern indicates the subarachnoid space in the posterior fossa. The horizontal-striped pattern indicates the subarachnoid space in the basal cistern and Sylvian fissure, the checked pattern indicates the subarachnoid space in the frontal convexity subarachnoid space, and the dotted pattern indicates the subarachnoid space in the parietal convexity subarachnoid space.

Tables

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    Table 1:

    Clinical characteristics of the study population

    iNPHiNPH + ADADControlP1aP2bP3c
    Total No.30101826
    Male2221015.343.155.342
    Mean age (yr)77.0 ± 6.679.7 ± 7.779.1 ± 5.075.2 ± 7.2.281.485.292
    • ↵a P1 indicates the probability value of iNPH vs AD.

    • ↵b P2 indicates the probability value of iNPH +AD vs AD.

    • ↵c P3 indicates the probability value of iNPH vs controls.

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    Table 2:

    Mean values and SDs for measurements

    iNPH (n = 30)iNPH + AD (n = 10)AD (n = 18)Controls (n = 26)P1aP2b
    Width of the ventricle at AC level (mm)41.2 ± 5.041.0 ± 5.935.6 ± 5.827.2 ± 6.2.002.014
    Width of the brain at AC level (mm)29.7 ± 3.529.3 ± 3.633.2 ± 4.640.7 ± 4.2.006.029
    Width of the ventricle at PC level (mm)35.3 ± 6.132.9 ± 4.728.7 ± 6.918.8 ± 6.2.002.027
    Width of the brain at PC level (mm)29.6 ± 3.931.0 ± 3.034.0 ± 5.341.9 ± 4.7.010.150
    BVR at AC level0.74 ± 0.160.75 ± 0.260.98 ± 0.311.59 ± 0.45<.001<.001
    BVR at PC level0.88 ± 0.250.97 ± 0.251.34 ± 0.762.54 ± 1.08<.001<.001
    Evans index0.34 ± 0.040.34 ± 0.370.32 ± 0.400.28 ± 3.8.079.286
    z-Evans index0.43 ± 0.040.43 ± 0.610.38 ± 0.610.29 ± 6.3.001.016
    Callosal angle (degree)65.0 ± 20.261.0 ± 15.586.1 ± 24.0103.7 ± 15.9.005.010
    Total intracranial volume (mL)1519 ± 1271457 ± 1391513 ± 2001484 ± 146.741.443
    Total CSF volume (mL)433.2 ± 82.0408.7 ± 105406.6 ± 97.1332.2 ± 112.428.654
    Brain parenchyma volume (mL)1086 ± 85.41048 ± 1201106 ± 1451152 ± 157.358.175
    • ↵a P1 indicates a probability value of iNPH vs AD based on the Mann-Whitney–Wilcoxon test.

    • ↵b P2 indicates the probability value of iNPH +AD vs AD based on the Mann-Whitney–Wilcoxon test.

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American Journal of Neuroradiology: 37 (7)
American Journal of Neuroradiology
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1 Jul 2016
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Cite this article
S. Yamada, M. Ishikawa, K. Yamamoto
Comparison of CSF Distribution between Idiopathic Normal Pressure Hydrocephalus and Alzheimer Disease
American Journal of Neuroradiology Jul 2016, 37 (7) 1249-1255; DOI: 10.3174/ajnr.A4695

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Comparison of CSF Distribution between Idiopathic Normal Pressure Hydrocephalus and Alzheimer Disease
S. Yamada, M. Ishikawa, K. Yamamoto
American Journal of Neuroradiology Jul 2016, 37 (7) 1249-1255; DOI: 10.3174/ajnr.A4695
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