Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study

Kristy Tan, Avital Meiri, Wenzhu B. Mowrey, Rick Abbott, James T. Goodrich, Adam L. Sandler, Asif K. Suri, Michael L. Lipton, Mark E. Wagshul

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVEThe object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.METHODSPatients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5% false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.RESULTSTwenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.CONCLUSIONSThe study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus.

Original languageEnglish (US)
Pages (from-to)1611-1622
Number of pages12
JournalJournal of Neurosurgery
Volume129
Issue number6
DOIs
StatePublished - Dec 1 2018

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Diffusion Tensor Imaging
Anisotropy
Hydrocephalus
Case-Control Studies
Headache
Linear Models
Internal Capsule
Corpus Callosum
Quality of Life
Outcome Assessment (Health Care)
White Matter
Equipment and Supplies

Keywords

  • AD = axial diffusivity
  • ALIC = anterior limb of internal capsule
  • CGC = cingulate gyrus component of the cingulum
  • CGH = hippocampal component of the cingulum
  • chronic shunting
  • diagnostic technique
  • diffusion tensor imaging
  • DTI = diffusion tensor imaging
  • FA = fractional anisotropy
  • FDR = false discovery rate
  • FOHR = frontal occipital horn ratio
  • gCC = genu of corpus callosum
  • HDI = Headache Disability Inventory
  • headache
  • HOQ = Hydrocephalus Outcome Questionnaire
  • ICP = intracranial pressure
  • MD = mean diffusivity
  • NPH = normal pressure hydrocephalus
  • pediatric hydrocephalus
  • PLIC = posterior limb of internal capsule
  • PVWM = periventricular white matter
  • QoL = quality of life
  • quality of life
  • RD = radial diffusivity
  • ROI = region of interest
  • sCC = splenium of corpus callosum
  • SVS = slit ventricle syndrome
  • TBSS = tract-based spatial statistics
  • tract-based spatial statistics

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{11265fb401f54c739fc5c0469fc1d52d,
title = "Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study",
abstract = "OBJECTIVEThe object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.METHODSPatients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5{\%} false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.RESULTSTwenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.CONCLUSIONSThe study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus.",
keywords = "AD = axial diffusivity, ALIC = anterior limb of internal capsule, CGC = cingulate gyrus component of the cingulum, CGH = hippocampal component of the cingulum, chronic shunting, diagnostic technique, diffusion tensor imaging, DTI = diffusion tensor imaging, FA = fractional anisotropy, FDR = false discovery rate, FOHR = frontal occipital horn ratio, gCC = genu of corpus callosum, HDI = Headache Disability Inventory, headache, HOQ = Hydrocephalus Outcome Questionnaire, ICP = intracranial pressure, MD = mean diffusivity, NPH = normal pressure hydrocephalus, pediatric hydrocephalus, PLIC = posterior limb of internal capsule, PVWM = periventricular white matter, QoL = quality of life, quality of life, RD = radial diffusivity, ROI = region of interest, sCC = splenium of corpus callosum, SVS = slit ventricle syndrome, TBSS = tract-based spatial statistics, tract-based spatial statistics",
author = "Kristy Tan and Avital Meiri and Mowrey, {Wenzhu B.} and Rick Abbott and Goodrich, {James T.} and Sandler, {Adam L.} and Suri, {Asif K.} and Lipton, {Michael L.} and Wagshul, {Mark E.}",
year = "2018",
month = "12",
day = "1",
doi = "10.3171/2017.6.JNS162784",
language = "English (US)",
volume = "129",
pages = "1611--1622",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "6",

}

TY - JOUR

T1 - Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus

T2 - a matched case-control study

AU - Tan, Kristy

AU - Meiri, Avital

AU - Mowrey, Wenzhu B.

AU - Abbott, Rick

AU - Goodrich, James T.

AU - Sandler, Adam L.

AU - Suri, Asif K.

AU - Lipton, Michael L.

AU - Wagshul, Mark E.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - OBJECTIVEThe object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.METHODSPatients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5% false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.RESULTSTwenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.CONCLUSIONSThe study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus.

AB - OBJECTIVEThe object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.METHODSPatients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5% false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.RESULTSTwenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.CONCLUSIONSThe study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus.

KW - AD = axial diffusivity

KW - ALIC = anterior limb of internal capsule

KW - CGC = cingulate gyrus component of the cingulum

KW - CGH = hippocampal component of the cingulum

KW - chronic shunting

KW - diagnostic technique

KW - diffusion tensor imaging

KW - DTI = diffusion tensor imaging

KW - FA = fractional anisotropy

KW - FDR = false discovery rate

KW - FOHR = frontal occipital horn ratio

KW - gCC = genu of corpus callosum

KW - HDI = Headache Disability Inventory

KW - headache

KW - HOQ = Hydrocephalus Outcome Questionnaire

KW - ICP = intracranial pressure

KW - MD = mean diffusivity

KW - NPH = normal pressure hydrocephalus

KW - pediatric hydrocephalus

KW - PLIC = posterior limb of internal capsule

KW - PVWM = periventricular white matter

KW - QoL = quality of life

KW - quality of life

KW - RD = radial diffusivity

KW - ROI = region of interest

KW - sCC = splenium of corpus callosum

KW - SVS = slit ventricle syndrome

KW - TBSS = tract-based spatial statistics

KW - tract-based spatial statistics

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U2 - 10.3171/2017.6.JNS162784

DO - 10.3171/2017.6.JNS162784

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