title: Cerebral perfusion measured by dynamic susceptibility contrast MRI is reduced in patients with idiopathic normal pressure hydrocephalus.
abstract: OBJECTIVE
  To demonstrate in idiopathic normal pressure hydrocephalus (iNPH) patients by dynamic susceptibility contrast MRI a reduced preoperative cerebral blood flow (CBF) which correlates with the severity of clinical symptoms and predicts shunt outcome.
  
  
  METHODS
  In cortical, subcortical, periventricular regions and along peri-and paraventricular profiles absolute perfusion values were estimated by multi-slice DSC MRI in 21 iNPH patients and 16 age-matched healthy individuals (HI). Relative CBF (rCBF), calculated with the occipital cortex as internal reference, was used for comparison between groups and for correlation analysis between regional rCBF and symptoms or outcome.
  
  
  RESULTS
  iNPH patients showed significantly decreased rCBF in the basal medial frontal cortex, hippocampus, lentiform nucleus, periventricular white matter (PVWM), central grey matter and the global parenchyma as compared to HI. iNPH patients with higher preoperative rCBF in the PVWM performed better in clinical tests. A lower overall preoperative function resulted in a more obvious recovery after shunt insertion. Shunt-responders had higher rCBF values in the basal medial frontal cortex than non-responders.
  
  
  CONCLUSIONS
  DSC MRI perfusion is a potentially useful diagnostic tool in iNPH and perfusion based criteria might be possible predictors of shunt response.
authors.affiliation: Department of Neuroradiology, Institute of Clinical Sciences, Gothenburg, Sweden.
authors.forename: Doerthe
authors.initials: D
authors.lastname: Ziegelitz
authors.forename: Göran
authors.initials: G
authors.lastname: Starck
authors.forename: David
authors.initials: D
authors.lastname: Kristiansen
authors.forename: Martin
authors.initials: M
authors.lastname: Jakobsson
authors.forename: Maria
authors.initials: M
authors.lastname: Hultenmo
authors.forename: Irene K
authors.initials: IK
authors.lastname: Mikkelsen
authors.forename: Per
authors.initials: P
authors.lastname: Hellström
authors.forename: Mats
authors.initials: M
authors.lastname: Tullberg
authors.forename: Carsten
authors.initials: C
authors.lastname: Wikkelsø
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology* / Q000601:surgery; D001931:Brain Mapping / Q000379:methods*; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003287:Contrast Media; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000503:physiopathology* / Q000601:surgery; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: cerebral blood flow; dynamic susceptibility contrast MRI; idiopathic normal pressure hydrocephalus; shunt response