Clinical Correlation of Abnormal Findings on Magnetic Resonance Elastography in Idiopathic Normal Pressure Hydrocephalus.

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Clinical Correlation of Abnormal Findings on Magnetic Resonance Elastography in Idiopathic Normal Pressure Hydrocephalus.

World Neurosurg. 2017 Jan 04;:

Authors: Perry A, Graffeo CS, Fattahi N, ElSheikh MM, Cray N, Arani A, Ehman RL, Glaser KJ, Manduca A, Meyer FB, Huston J

Abstract
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is ventriculomegaly syndrome characterized by dementia, urinary incontinence, and gait disturbance, which is potentially reversible following ventriculoperitoneal shunting (VPS). Magnetic resonance elastography (MRE) is an evolving imaging technology that noninvasively measures tissue viscoelasticity.
OBJECTIVE: We studied iNPH patients using MRE prior to shunting, compared them to normal controls, and analyzed associations between MRE findings and clinical features, as a pilot assessment of MRE in iNPH.
METHODS: Stiffness values were measured on preoperative MRE in 10 iNPH patients scheduled for VPS, and compared with those in 20 age- and sex-matched controls. Stiffness results were correlated with clinical iNPH symptoms.
RESULTS: MRE demonstrated significantly increased stiffness in iNPH in cerebrum (p=0.04), occipital (p=0.002), and parietal (p=0.01) regions-of-interest (ROI), and significantly decreased stiffness in periventricular ROI (p<0.0001). Stiffness was not significant different in frontal (p=0.1) and deep grey ROI (p=0.4). Univariate analysis showed associations between preoperative iNPH symptoms and abnormally increased stiffness, including urinary incontinence with cerebrum (p=0.005), frontal (p=0.04), and cerebellum (p=0.03), and Parkinsonism with occipital (p=0.04). Postoperative improvement was associated with increased deep grey stiffness (p=0.01); failure was associated with increased temporal (p=0.0002) stiffness.
CONCLUSION: Based on the preliminary results of this small, limited analysis, brain stiffness may be altered in iNPH, and these alterations in parenchymal viscoelastic properties may be correlated with clinical symptoms. Increased temporal stiffness may predict surgical failure, and potentially suggest an alternative dementing pathology underlying the iNPH-like symptoms. These findings highlight the potential future utility of MRE in iNPH management.

PMID: 28063896 [PubMed - as supplied by publisher]

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