特发性正常压力脑积水与阿尔茨海默病脑脊液分布的比较
Comparison of CSF Distribution between Idiopathic Normal Pressure Hydrocephalus and Alzheimer Disease.
作者信息
Yamada S, Ishikawa M, Yamamoto K
机构信息
From the Normal Pressure Hydrocephalus Center (S.Y., M.I.) Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.
Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.
出版信息
AJNR Am J Neuroradiol. 2016 Jul;37(7):1249-55. doi: 10.3174/ajnr.A4695. Epub 2016 Feb 25.
BACKGROUND AND PURPOSE
CSF volumes in the basal cistern and Sylvian fissure are increased in both idiopathic normal pressure hydrocephalus and Alzheimer disease, though the differences in these volumes in idiopathic normal pressure hydrocephalus and Alzheimer disease have not been well-described. Using CSF segmentation and volume quantification, we compared the distribution of CSF in idiopathic normal pressure hydrocephalus and Alzheimer disease.
MATERIALS AND METHODS
CSF volumes were extracted from T2-weighted 3D spin-echo sequences on 3T MR imaging and quantified semi-automatically. We compared the volumes and ratios of the ventricles and subarachnoid spaces after classification in 30 patients diagnosed with idiopathic normal pressure hydrocephalus, 10 with concurrent idiopathic normal pressure hydrocephalus and Alzheimer disease, 18 with Alzheimer disease, and 26 control subjects 60 years of age or older.
RESULTS
Brain to ventricle ratios at the anterior and posterior commissure levels and 3D volumetric convexity cistern to ventricle ratios were useful indices for the differential diagnosis of idiopathic normal pressure hydrocephalus or idiopathic normal pressure hydrocephalus with Alzheimer disease from Alzheimer disease, similar to the z-Evans index and callosal angle. The most distinctive characteristics of the CSF distribution in idiopathic normal pressure hydrocephalus were small convexity subarachnoid spaces and the large volume of the basal cistern and Sylvian fissure. The distribution of the subarachnoid spaces in the idiopathic normal pressure hydrocephalus with Alzheimer disease group was the most deformed among these 3 groups, though the mean ventricular volume of the idiopathic normal pressure hydrocephalus with Alzheimer disease group was intermediate between that of the idiopathic normal pressure hydrocephalus and Alzheimer disease groups.
CONCLUSIONS
The z-axial expansion of the lateral ventricle and compression of the brain just above the ventricle were the common findings in the parameters for differentiating idiopathic normal pressure hydrocephalus from Alzheimer disease.
背景与目的
特发性正常压力脑积水和阿尔茨海默病患者的基底池和外侧裂脑脊液容量均增加，不过特发性正常压力脑积水与阿尔茨海默病患者这些容量的差异尚未得到充分描述。我们采用脑脊液分割和容量定量技术，比较了特发性正常压力脑积水和阿尔茨海默病患者脑脊液的分布情况。
材料与方法
在3T磁共振成像上，从T2加权三维自旋回波序列中提取脑脊液容量，并进行半自动定量分析。我们比较了30例诊断为特发性正常压力脑积水患者、10例同时患有特发性正常压力脑积水和阿尔茨海默病患者、18例阿尔茨海默病患者以及26例60岁及以上对照者分类后的脑室和蛛网膜下腔的容量及比例。
结果
前后连合水平的脑与脑室比例以及三维容积性凸面池与脑室比例是鉴别特发性正常压力脑积水或合并阿尔茨海默病的特发性正常压力脑积水与阿尔茨海默病的有用指标，类似于z - Evans指数和胼胝体角。特发性正常压力脑积水脑脊液分布最显著的特征是凸面蛛网膜下腔小，基底池和外侧裂容量大。在这三组中，合并阿尔茨海默病的特发性正常压力脑积水组蛛网膜下腔的分布变形最严重，不过合并阿尔茨海默病的特发性正常压力脑积水组的平均脑室容量介于特发性正常压力脑积水组和阿尔茨海默病组之间。
结论
侧脑室的z轴扩张以及脑室上方脑的受压是鉴别特发性正常压力脑积水与阿尔茨海默病参数中的常见表现。
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