title: In Patients With Idiopathic Normal Pressure Hydrocephalus Postoperative Cerebral Perfusion Changes Measured by Dynamic Susceptibility Contrast Magnetic Resonance Imaging Correlate With Clinical Improvement.
abstract: OBJECTIVE
  To explore relationships between clinical improvement and relative cerebral blood flow (rCBF) changes after shunt-insertion in idiopathic normal pressure hydrocephalus (iNPH) as measured by dynamic susceptibility contrast magnetic resonance imaging.
  
  
  METHODS
  In 20 idiopathic normal pressure hydrocephalus patients rCBF was measured preoperatively and 3 months postoperatively. Because of shunt-induced right-sided artefacts, evaluation was restricted to 12 left-sided cortical, subcortical, and periventricular regions of interest. Correlations between rCBF and clinical symptoms were analyzed in shunt responders.
  
  
  RESULTS
  In responders, the postoperative regions of interest-based rCBF increase of 2% to 9% was significant in the parenchyma, the hippocampus, and the anterior periventricular white matter. Perfusion improvement in the cingulus, caudate head, and thalamus correlated with decreased disturbance in one or more of the domains neuropsychology, gait, balance, and total performance.
  
  
  CONCLUSIONS
  Apparently, dynamic susceptibility contrast magnetic resonance imaging can measure postoperative perfusion changes in responders. Postoperatively, perfusion increase in some grey matter structures seems to determine the degree of clinical improvement.
authors.affiliation: From the *Department of Neuroradiology, †Department of Radiation Physics at the Institute of Clinical Sciences, ‡Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital; §Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Doerthe
authors.initials: D
authors.lastname: Ziegelitz
authors.forename: Jonathan
authors.initials: J
authors.lastname: Arvidsson
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
authors.forename: Göran
authors.initials: G
authors.lastname: Starck
mesh_terms: D001921:Brain / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis* / Q000503:physiopathology*; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA