Optimal Diagnostic indices for idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space
Optimal Diagnostic indices for idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space
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DOI：
10.3174/ajnr.a4440
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发表时间：
2015-12-01
影响因子：
3.5
通讯作者：
Yamamoto, K.
中科院分区：
文献类型：
--
作者：
Yamada, S.;Ishikawa, M.;Yamamoto, K.
背景和目的：尽管3D图形技术取得了显著的进步，但Evans指数一直是最常用的心室扩大指数。我们研究了一种新的可靠的指数为特发性正常压力脑积水的MR成像特征，而不是埃文斯index.MATERIALS和METHODS：怀疑特发性正常压力脑积水的基础上的脑室扩大和三联征的症状的患者进行了脑脊液水龙头试验。CSF体积从3 T MR成像上的T2加权3D自旋回波序列中提取，并半自动定量，该序列名为“使用不同翻转角演变（SPACE）的应用优化对比度的采样完美性”。蛛网膜下腔分为额凸面、顶凸面、侧裂和基底池、后颅窝的上下两部分及4个室。测量双侧脑室及其前角3个轴向的最大长度。“z-Evans指数”定义为额骨最大z轴长度与颅部最大z轴长度之比。这些参数进行了评估的预测准确性为自来水阳性组相比，自来水阴性组和年龄调整的优势比在最佳thresholds.Results：在这项研究中，24例自来水阳性特发性正常压力脑积水，25例无反应的自来水试验，23名年龄匹配的对照。双侧脑室的前角扩张，最过度的扩张是朝向z方向。顶凸区脑脊液容量的受试者工作特征曲线下面积最大（0.768），z-Evans指数次之（0.758），上下蛛网膜下腔比值指数次之（0.723）。
BACKGROUND AND PURPOSE: Despite the remarkable progress of 3D graphics technology, the Evans index has been the most popular index for ventricular enlargement. We investigated a novel reliable index for the MR imaging features specified in idiopathic normal pressure hydrocephalus, rather than the Evans index.MATERIALS AND METHODS: The patients with suspected idiopathic normal pressure hydrocephalus on the basis of the ventriculomegaly and a triad of symptoms underwent the CSF tap test. CSF volumes were extracted from a T2-weighted 3D spin-echo sequence named "sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE)" on 3T MR imaging and were quantified semiautomatically. Subarachnoid spaces were divided as follows: upper and lower parts and 4 compartments of frontal convexity, parietal convexity, Sylvian fissure and basal cistern, and posterior fossa. The maximum length of 3 axial directions in the bilateral ventricles and their frontal horns was measured. The "z-Evans Index" was defined as the maximum z-axial length of the frontal horns to the maximum cranial z-axial length. These parameters were evaluated for the predictive accuracy for the tap-positive groups compared with the tap-negative groups and age-adjusted odds ratios at the optimal thresholds.RESULTS: In this study, 24 patients with tap-positive idiopathic normal pressure hydrocephalus, 25 patients without response to the tap test, and 23 age-matched controls were included. The frontal horns of the bilateral ventricles were expanded, with the most excessive expansion being toward the z-direction. The CSF volume of the parietal convexity had the highest area under the receiver operating characteristic curve (0.768), the z-Evans Index was the second (0.758), and the upper-to-lower subarachnoid space ratio index was the third (0.723), to discriminate the tap-test response.CONCLUSIONS: The CSF volume of the parietal convexity of