使用扩散张量成像评估特发性正常压力脑积水及其模仿疾病中淋巴系统的诊断效能
Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers.
作者信息
Yokota Hajime, Vijayasarathi Arvind, Cekic Milos, Hirata Yoko, Linetsky Michael, Ho Michael, Kim Won, Salamon Noriko
机构信息
Chiba University, Department of Radiology, Chiba, Japan.
UCLA Department of Radiological Sciences, Los Angeles, CA, USA.
出版信息
Curr Gerontol Geriatr Res. 2019 Jun 20;2019:5675014. doi: 10.1155/2019/5675014. eCollection 2019.
PURPOSE
To investigate the pathological change of the glymphatic system in idiopathic normal pressure hydrocephalus (iNPH) using diffusion tensor imaging (DTI) analysis.
MATERIALS AND METHODS
24 right-handed patients were referred to our hydrocephalus clinic for assessment of ventriculomegaly and gait impairment. 12 of 24 were diagnosed as pseudo-iNPH (piNPH) based on assessment by a neurologist. Diffusivity maps in the direction of the x-axis (right-to-left) (Dx), y-axis (anterior-to-posterior) (Dy), and z-axis (inferior-to-superior) (Dz) were computed. The diffusion map was coregistered to International Consortium for Brain Mapping (ICBM) DTI-81 atlas. The analysis along the perivascular space (ALPS) index was defined as mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where Dxpro and Dxasc are Dx values in the projection and association fiber areas, respectively. Evans index and callosal angle were also assessed on each case.
RESULTS
ALPS indexes of the control, piNPH, and iNPH cases were 1.18 ± 0.08, 1.08 ± 0.03, and 0.94 ± 0.06, respectively, and there were significant differences among the groups (control vs. piNPH, P = 0.003; control vs. iNPH P < 0.001; piNPH vs. iNPH, P < 0.001). Area under curve (AUC) was 0.92, 1.00, and 1.00 on control vs. piNPH, control vs. iNPH, and piNPH vs. iNPH on ROC analysis. Between piNPH and NPH, ALPS index has higher diagnostic performance than Evans index and callosal angle (AUC = 1.00 vs. 0.84, P = 0.028; AUC = 1.00 vs. 0.74, P = 0.016).
CONCLUSION
Atlas-based ALPS index using the DTI method differentiated among iNPH, piNPH, and controls clearly.
目的
采用扩散张量成像（DTI）分析研究特发性正常压力脑积水（iNPH）中脑淋巴系统的病理变化。
材料与方法
24名右利手患者被转诊至我们的脑积水门诊，以评估脑室扩大和步态障碍情况。24名患者中，12名经神经科医生评估被诊断为假性特发性正常压力脑积水（piNPH）。计算x轴（从右到左）（Dx）、y轴（从前到后）（Dy）和z轴（从下到上）（Dz）方向的扩散率图。将扩散图与国际脑图谱联盟（ICBM）DTI - 81图谱进行配准。沿血管周围间隙分析（ALPS）指数定义为平均（Dxpro，Dypro）/平均（Dypro，Dzasc），其中Dxpro和Dxasc分别是投射纤维区和联合纤维区的Dx值。对每个病例还评估了埃文斯指数和胼胝体角。
结果
对照组、piNPH组和iNPH组的ALPS指数分别为1.18±0.08、1.08±0.03和0.94±0.06，各组之间存在显著差异（对照组与piNPH组，P = 0.003；对照组与iNPH组，P < 0.001；piNPH组与iNPH组，P < 0.001）。在ROC分析中，对照组与piNPH组、对照组与iNPH组、piNPH组与iNPH组的曲线下面积（AUC）分别为0.92、1.00和1.00。在piNPH组和NPH组之间，ALPS指数的诊断性能高于埃文斯指数和胼胝体角（AUC = 1.00对0.84，P = 0.028；AUC = 1.00对0.74，P = 0.016）。
结论
基于图谱的使用DTI方法的ALPS指数能够清晰地区分iNPH、piNPH和对照组。
Zotero 插件