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Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation

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Abstract

Evidence suggests that normal pressure hydrocephalus (NPH) is underdiagnosed in day to day radiologic practice, and differentiating NPH from cerebral atrophy due to other neurodegenerative diseases and normal aging remains a challenge. To better characterize NPH, we test the hypothesis that a prediction model based on automated MRI brain tissue segmentation can help differentiate shunt-responsive NPH patients from cerebral atrophy due to Alzheimer disease (AD) and normal aging. Brain segmentation into gray and white matter (GM, WM), and intracranial cerebrospinal fluid was derived from pre-shunt T1-weighted MRI of 15 shunt-responsive NPH patients (9 men, 72.6 ± 8.0 years-old), 17 AD patients (10 men, 72.1 ± 11.0 years-old) chosen as a representative of cerebral atrophy in this age group; and 18 matched healthy elderly controls (HC, 7 men, 69.7 ± 7.0 years old). A multinomial prediction model was generated based on brain tissue volume distributions. GM decrease of 33 % relative to HC characterized AD (P < 0.005). High preoperative ventricular and near normal GM volumes characterized NPH. A multinomial regression model based on gender, GM and ventricular volume had 96.3 % accuracy differentiating NPH from AD and HC. In conclusion, automated MRI brain tissue segmentation differentiates shunt-responsive NPH with high accuracy from atrophy due to AD and normal aging. This method may improve diagnosis of NPH and improve our ability to distinguish normal from pathologic aging.

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Abbreviations

NPH:

Normal pressure hydrocephalus

AD:

Alzheimer disease

HC:

Healthy control

CSF:

Cerebrospinal fluid

GM:

Gray matter

WM:

White matter

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Acknowledgments

This research was supported by the National Institutes of Health Grants AG012101, AG027852, AG08051, EB01015 and NS050520. We wish to acknowledge the assistance of Dr. Joseph A. Helpern in providing data obtained from his grants (AG 027852 and The Litwin Foundation) for analysis, and Patricia Tolete for her assistance in reviewing medical records.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflicts of interest.

Ethical Standards

This study has been performed in accordance with the standards laid down in the Declaration of Helsinki.

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Author notes

  1. Yafell Serulle

    Present address: Department of Radiology, University of Maryland Medical Center, 22 S. Greene St., Baltimore, MD, 21201, USA

Authors and Affiliations

  1. Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA

    Yafell Serulle, Henry Rusinek, Ivan I. Kirov, Hannah Milch, Els Fieremans, Alexander B. Baxter, John McMenamy, Rajan Jain, Oded Gonen & Ajax E. George

  2. Department of Neurosurgery, New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA

    Jeffrey Wisoff

  3. Departments of Neurology and Psychiatry, Center for Adult Hydrocephalus, New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA

    James Golomb

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  1. Yafell Serulle
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  2. Henry Rusinek
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  3. Ivan I. Kirov
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  4. Hannah Milch
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  11. Oded Gonen
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  12. Ajax E. George
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Correspondence to Yafell Serulle.

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Serulle, Y., Rusinek, H., Kirov, I.I. et al. Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation. J Neurol 261, 1994–2002 (2014). https://doi.org/10.1007/s00415-014-7454-0

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  • DOI: https://doi.org/10.1007/s00415-014-7454-0

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