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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
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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
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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
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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
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Methods Patients 22 NPH (non-DESH) 11 NPH (DESH) 23 Alzheimer Disease
25 Healthy Controls
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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
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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)
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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
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Acknowledgements Dr. Ajax George, MD Dr. James B. Golomb, MD
Benjamin Ades-Aron, BS, MS Dr. Henry Rusinek, PhD
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