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Diffusion Tensor Imaging in Patients With Adult Chronic Idiopathic Hydrocephalus

Hattingen, Elke MD; Jurcoane, Alina MD, PhD; Melber, Julia; Blasel, Stella MD; Zanella, Friedhelm E. MD, PhD; Neumann-Haefelin, Tobias MD, PhD; Singer, Oliver C. MD

doi: 10.1227/01.NEU.0000367801.35654.EC
Clinical Studies

OBJECTIVE: Diffusion tensor imaging (DTI) parameters were investigated in patients with chronic idiopathic hydrocephalus to evaluate microstructural changes of brain tissue caused by chronic ventricular dilatation.

METHODS: Eleven patients fulfilling the criteria for possible or probable idiopathic normal pressure hydrocephalus and 10 healthy control subjects underwent MRI at 3 Tesla, including DTI with 12 gradient directions. Patients were scanned before lumbar cerebrospinal fluid (CSF) withdrawal tests. Differences in fractional anisotropy (FA) and mean diffusivity (MD) between patients and controls were assessed using 2 different methods: manual definition of regions of interest and a fully automated method, TBSS (Tract-Based Spatial Statistics). DTI parameters were correlated with clinical findings.

RESULTS: Compared with the control group, patients with chronic idiopathic hydrocephalus had significantly higher MD values in both the periventricular corticospinal tract (CST) and the corpus callosum (CC), whereas FA values were significantly higher in the CST but lower in the CC. DTI parameters of the CST correlated with the severity of gait disturbances.

CONCLUSION: Microstructural changes in periventricular functionally relevant white matter structures (CSF, CC) in chronic idiopathic hydrocephalus can be visualized using DTI. Further studies should investigate the change of DTI parameters after CSF shunting and its relation to neurologic outcome.

Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany (Hattingen) (Blasel) (Zanella)

Institute of Neuroradiology, Goethe University, and Center for Research on Individual Development and Adaptive Education, Frankfurt am Main, Germany (Jurcoane)

Department of Neurology, Goethe University, Frankfurt am Main, Germany (Melber) (Neumann-Haefelin) (Singer)

Reprint requests: Elke Hattingen, MD, Goethe University Frankfurt, Institute of Neuroradiology, Schleusenweg 2–16, 60528 Frankfurt, Germany E-mail:

Received, December 18, 2008

Accepted, November 22, 2009

Copyright © by the Congress of Neurological Surgeons