title: Idiopathic normal pressure hydrocephalus: cerebral perfusion measured with pCASL before and repeatedly after CSF removal.
abstract: Pseudo-continuous arterial spin labeling (pCASL) measurements were performed in 20 patients with idiopathic normal pressure hydrocephalus (iNPH) to investigate whether cerebral blood flow (CBF) increases during the first 24 hours after a cerebrospinal fluid tap test (CSF TT). Five pCASL magnetic resonance imaging (MRI) scans were performed. Two scans were performed before removal of 40 mL CSF, and the other three at 30 minutes, 4 hours, and 24 hours, respectively after the CSF TT. Thirteen different regions of interest (ROIs) were manually drawn on coregistered MR images. In patients with increased CBF in lateral and frontal white matter after the CSF TT, gait function improved more than it did in patients with decreased CBF in these regions. However, in the whole sample, there was no significant increase in CBF after CSF removal compared with baseline investigations. The repeatability of CBF measurements at baseline was high, with intraclass correlation coefficients of 0.60 to 0.90 for different ROIs, but the median regional variability was in the range of 5% to 17%. Our results indicate that CBF in white matter close to the lateral ventricles plays a role in the reversibility of symptoms after CSF removal in patients with iNPH.
authors.affiliation: Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Virhammar
authors.affiliation: 1] Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden [2] Department of Pharmacology and Clinical Neuroscience, Neurology, Östersund, Umeå University, Umeå, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Laurell
authors.affiliation: Department of Medical Radiation Physics, Lund University, Lund, Sweden.
authors.forename: André
authors.initials: A
authors.lastname: Ahlgren
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.
authors.forename: Kristina Giuliana
authors.initials: KG
authors.lastname: Cesarini
authors.affiliation: Department of Radiology, Uppsala University, Uppsala, Sweden.
authors.forename: Elna-Marie
authors.initials: EM
authors.lastname: Larsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002540:Cerebral Cortex / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D011859:Radiography; D013997:Time Factors