Differentiating Normal Pressure Hydrocephalus from Alzheimer Disease and Healthy Controls: Sulcal Depth Alexander M. Le, M.S., Benjamin Ades-Aron, M.S.,

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Presentation transcript:

Differentiating Normal Pressure Hydrocephalus from Alzheimer Disease and Healthy Controls: Sulcal Depth Alexander M. Le, M.S., Benjamin Ades-Aron, M.S., Hersh Patel, B.S., James Golomb, MD, Henry Rusinek, PhD, Ajax George, MD ASNR 2016

Normal Pressure Hydrocephalus (NPH) Population: Elderly, 6th-7th decade Triad: gait disturbance cognitive deficits urinary incontinence Diagnosis Lumbar tap test Treatment Surgical Shunt Normal pressure hydrocephalus: Treatable neurological syndrome of the elderly Classic Triad: 1) gait disturbance 2) cognitive deficits 3) urinary incontinence Narrowing of sylvian fissure Normal Focal sulcal dilatation Highly enlarged sylvian fissure

Imaging findings Ventriculomegaly Parietal compression Tight high-convexity of medial subarachnoid spaces Enlarged sylvian fissures Focal sulcal dilatation Purpose: to identify cortical sulcal patterns using sulcal depth measurements to characterize NPH Sylvian fissure narrowing Normal Moderately enlarged Highly enlarged

Disproportionately enlarged sulci hydrocephalus (DESH) Ventriculomegaly Tight high-convexity and medial subarachnoid spaces Disproportionate distribution of CSF in the subarachnoid space Inferior > Superior Enlarged Sylvian fissures

Methods Patients 22 NPH (non-DESH) 11 NPH (DESH) 23 Alzheimer Disease 25 Healthy Controls

Methods High-resolution T1-weighted MPRAGE sequences, 3T MRI system FreeSurfer software (Linux) Segmentation Reconstruction of pial surface Reconstruction of inner skull surface MATLAB in-house software Measurement of the sulcal depth: length of vector from the sulci to the inner table of the skull Statistical analysis Vertex-wise t-tests co-varying for age and total-intracranial volume Clusterwise correction for multiple comparisons

Study Results p-value HC vs NPH (non-DESH) NPH (non-DESH) has shallower sulci in pre-central sulcus vs HC (P*** < 0.005) HC vs NPH (DESH) NPH (DESH) has shallower sulci in central sulcus vs HC HC vs AD No statistical differences (P > 0.05) NPH (non-DESH) vs AD NPH (DESH) vs AD NPH (DESH) has shallower sulci in central sulcus vs Alzheimer Disease (P* < 0.05) NPH (non-DESH) vs DESH NPH (non-DESH) has deeper sulci in central sulcus vs NPH (DESH)

Conclusion NPH (non-DESH) and NPH (DESH) patients exhibit shallower sulci in pre-central and central sulcus compared to HC and AD Enlarged ventricles from within brain compressing gyri against inner skull No difference in the sylvian fissure depth

Acknowledgements Dr. Ajax George, MD Dr. James B. Golomb, MD Benjamin Ades-Aron, BS, MS Dr. Henry Rusinek, PhD