title: Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation.
abstract: Evidence suggests that normal pressure hydrocephalus (NPH) is underdiagnosed in day to day radiologic practice, and differentiating NPH from cerebral atrophy due to other neurodegenerative diseases and normal aging remains a challenge. To better characterize NPH, we test the hypothesis that a prediction model based on automated MRI brain tissue segmentation can help differentiate shunt-responsive NPH patients from cerebral atrophy due to Alzheimer disease (AD) and normal aging. Brain segmentation into gray and white matter (GM, WM), and intracranial cerebrospinal fluid was derived from pre-shunt T1-weighted MRI of 15 shunt-responsive NPH patients (9 men, 72.6 ± 8.0 years-old), 17 AD patients (10 men, 72.1 ± 11.0 years-old) chosen as a representative of cerebral atrophy in this age group; and 18 matched healthy elderly controls (HC, 7 men, 69.7 ± 7.0 years old). A multinomial prediction model was generated based on brain tissue volume distributions. GM decrease of 33% relative to HC characterized AD (P < 0.005). High preoperative ventricular and near normal GM volumes characterized NPH. A multinomial regression model based on gender, GM and ventricular volume had 96.3% accuracy differentiating NPH from AD and HC. In conclusion, automated MRI brain tissue segmentation differentiates shunt-responsive NPH with high accuracy from atrophy due to AD and normal aging. This method may improve diagnosis of NPH and improve our ability to distinguish normal from pathologic aging.
authors.affiliation: Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA, yserulle@umm.edu.
authors.forename: Yafell
authors.initials: Y
authors.lastname: Serulle
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
authors.forename: Ivan I
authors.initials: II
authors.lastname: Kirov
authors.forename: Hannah
authors.initials: H
authors.lastname: Milch
authors.forename: Els
authors.initials: E
authors.lastname: Fieremans
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Baxter
authors.forename: John
authors.initials: J
authors.lastname: McMenamy
authors.forename: Rajan
authors.initials: R
authors.lastname: Jain
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wisoff
authors.forename: James
authors.initials: J
authors.lastname: Golomb
authors.forename: Oded
authors.initials: O
authors.lastname: Gonen
authors.forename: Ajax E
authors.initials: AE
authors.lastname: George
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D000544:Alzheimer Disease / Q000150:complications*; D000704:Analysis of Variance; D001921:Brain / Q000473:pathology*; D016022:Case-Control Studies; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000209:etiology / Q000473:pathology / Q000628:therapy; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D010865:Pilot Projects
references.citation: AJNR Am J Neuroradiol. 2000 Oct;21(9):1586-90
references.pmid: 11039335
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Arch Neurol. 1983 Oct 21;40(11):687-90
references.pmid: 6354151
references.citation: J Neurol. 2010 Oct;257(10):1675-81
references.pmid: 20512347
references.citation: Eur J Neurol. 2009 Apr;16(4):468-74
references.pmid: 19138329
references.citation: J Neurosurg. 1998 Nov;89(5):742-7
references.pmid: 9817411
references.citation: Neurol Med Chir (Tokyo). 2008;48 Suppl:S1-23
references.pmid: 18408356
references.citation: AJNR Am J Neuroradiol. 2012 Jan;33(1):97-103
references.pmid: 22016412
references.citation: Neurosurgery. 2011 Apr;68(4):939-44
references.pmid: 21221031
references.citation: Int Rev Neurobiol. 2009;84:263-81
references.pmid: 19501723
references.citation: J Clin Neurosci. 2003 Jul;10(4):453-9
references.pmid: 12852885
references.citation: N Engl J Med. 1965 Jul 15;273:117-26
references.pmid: 14303656
references.citation: Neuroimaging Clin N Am. 1995 Feb;5(1):19-31
references.pmid: 7743082
references.citation: J Neurol Neurosurg Psychiatry. 2013 May;84(5):562-8
references.pmid: 23250963
references.citation: J Neurol Sci. 2013 Nov 15;334(1-2):55-62
references.pmid: 23938354
references.citation: Br J Neurosurg. 2006 Aug;20(4):214-21
references.pmid: 16954071
references.citation: Neurosurgery. 2001 Nov;49(5):1166-84; discussion 1184-6
references.pmid: 11846911
references.citation: Physiotherapy. 1976 Apr;62(4):123-4
references.pmid: 1265153
references.citation: Neurosurg Clin N Am. 2001 Oct;12(4):661-84, viii
references.pmid: 11524288
references.citation: J Neurol Neurosurg Psychiatry. 2000 Jun;68(6):778-81
references.pmid: 10811706
references.citation: Dement Geriatr Cogn Disord. 2008;25(4):329-35
references.pmid: 18319598
references.citation: Acta Neurochir Suppl. 2005;95:241-5
references.pmid: 16463857
references.citation: J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):503-6
references.pmid: 11909911
references.citation: Radiology. 1996 Feb;198(2):523-9
references.pmid: 8596861
references.citation: Neurol Res Int. 2012;2012:718150
references.pmid: 21860791
references.citation: J Magn Reson Imaging. 2008 Jun;27(6):1235-41
references.pmid: 18504741
references.citation: AJNR Am J Neuroradiol. 1997 Jan;18(1):115-23
references.pmid: 9010529
references.citation: Neurosurgery. 2010 May;66(5):917-24
references.pmid: 20404696
references.citation: Neurology. 1982 Dec;32(12):1358-63
references.pmid: 6890641
references.citation: Am J Psychiatry. 1982 Sep;139(9):1136-9
references.pmid: 7114305
references.citation: Arch Neurol. 1986 Sep;43(9):940-2
references.pmid: 3741212
references.citation: Neuropathol Appl Neurobiol. 2012 Feb;38(1):72-86
references.pmid: 21696417
references.citation: Neurosurgery. 2007 Feb;60(2):327-32; discussion 332
references.pmid: 17290183
references.citation: Neuroimage. 2005 Jul 1;26(3):839-51
references.pmid: 15955494
references.citation: J Neurosurg. 2009 May;110(5):837-51
references.pmid: 18991499
references.citation: Neuroimage. 2003 Apr;18(4):895-907
references.pmid: 12725765
references.citation: AJNR Am J Neuroradiol. 2011 Sep;32(8):1496-503
references.pmid: 21700790
references.citation: Radiology. 1991 Jan;178(1):109-14
references.pmid: 1984287
references.citation: Neurosurgery. 2010 Nov;67(5):E1474
references.pmid: 20871429
references.citation: Neurology. 2000 Aug 22;55(4):576-8
references.pmid: 10953197
references.citation: AJNR Am J Neuroradiol. 1998 May;19(5):813-9
references.pmid: 9613493
references.citation: NeuroRehabilitation. 2002;17(3):255-62
references.pmid: 12237507
references.citation: AJNR Am J Neuroradiol. 1981 May-Jun;2(3):205-13
references.pmid: 6786056
references.citation: Neurosurgery. 2005 Sep;57(3 Suppl):S17-28; discussion ii-v
references.pmid: 16160426