Quantifying response to intracranial pressure normalization in idiopathic intracranial hypertension via dynamic neuroimaging

Lublinsky, Svetlana; Kesler, Anat; Friedman, Alon; Horev, Anat; Shelef, Ilan

doi:10.1002/jmri.25857

Cited by 13 publications

(12 citation statements)

References 33 publications

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“…While performing an MRI morphometric brain analysis study in patients suffering from type 1 complex regional pain syndrome (CRPS), Zhou et al (2015) serendipitously found a significant enlargement of ChPs compared with controls. The same phenomenon was observed with MRI in patients with idiopathic intracranial hypertension (IIH) (Figure 1A; Lublinsky et al, 2018). Using a different approach based on MRI texture analysis, Chaddad et al (2017) identified ChPs as one of the regions having the most significant differences between patients with autism spectrum disorders (ASD) and controls.…”

Section: Resultssupporting

confidence: 73%

“…Examples of different clinical imaging techniques available for investigating the involvement of ChPs in brain disorders. (A) 3D reconstruction of ChP located within lateral ventricles space [red, before lumbar puncture (LP), and gray, after LP] in a patient with idiopathic intracranial hypertension (Lublinsky et al, 2018); (B) ChP iron deposition (arrows on hypointense signals) detected by susceptibility-weighted MRI in a patient who had received both ultrasmall superparamagnetic particles of iron oxide (USPIOs) 2 years earlier and multiple blood transfusions since (Daldrup-Link, 2017); (C) signal-time curves extracted in the ChP from dynamic susceptibility contras-enhanced MRI data: the yellow curve represents the mean signal calculated from all the pixels in the ChP volume, while the blue and red curves represent, respectively, the curve with lowest and highest baseline. After first passage of the gadolinium bolus (signal drop), the choroidal signals visually exceed the baseline which indicates gadolinium chelate extravasation into the ChP stroma (Bouzerar et al, 2013); (D) PET/CT images showing the normal ChP uptake of [ 68 Ga]-DOTA-E-[c(RGDfK)] 2 targeting α v β 3 integrin ( This research was originally published in JNM.…”

Section: Resultsmentioning

confidence: 99%

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Clinical Imaging of Choroid Plexus in Health and in Brain Disorders: A Mini-Review

Hubert

Chauveau

Dumot

et al. 2019

Front. Mol. Neurosci.

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The choroid plexuses (ChPs) perform indispensable functions for the development, maintenance and functioning of the brain. Although they have gained considerable interest in the last years, their involvement in brain disorders is still largely unknown, notably because their deep location inside the brain hampers non-invasive investigations. Imaging tools have become instrumental to the diagnosis and pathophysiological study of neurological and neuropsychiatric diseases. This review summarizes the knowledge that has been gathered from the clinical imaging of ChPs in health and brain disorders not related to ChP pathologies. Results are discussed in the light of pre-clinical imaging studies. As seen in this review, to date, most clinical imaging studies of ChPs have used disease-free human subjects to demonstrate the value of different imaging biomarkers (ChP size, perfusion/permeability, glucose metabolism, inflammation), sometimes combined with the study of normal aging. Although very few studies have actually tested the value of ChP imaging biomarkers in patients with brain disorders, these pioneer studies identified ChP changes that are promising data for a better understanding and follow-up of diseases such as schizophrenia, epilepsy and Alzheimer’s disease. Imaging of immune cell trafficking at the ChPs has remained limited to pre-clinical studies so far but has the potential to be translated in patients for example using MRI coupled with the injection of iron oxide nanoparticles. Future investigations should aim at confirming and extending these findings and at developing translational molecular imaging tools for bridging the gap between basic molecular and cellular neuroscience and clinical research.

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Section: Resultssupporting

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Clinical Imaging of Choroid Plexus in Health and in Brain Disorders: A Mini-Review

Hubert

Chauveau

Dumot

et al. 2019

Front. Mol. Neurosci.

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“…Tortuous ON is not an essential diagnostic criteria for IIH in children (17), and while it is unclear if BEH and IIH are indeed analogous conditions, previous pediatric studies of both entities relied on neuroradiologists to determine anatomical deformity. In the current study we used a quantitative structural assessment to accurately identify ON tortuosity, previously implemented successfully in adults with IIH (14). Rarely, isolated non-traumatic elevated ICP and increased pressure across the ON sheath can result in retinal hemorrhage (22) but there is no available data on visual impairments in children with BEH.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, skeletons were combined with the CSF Euclidean distance transform map to estimate subarachnoid space and sulci thicknesses. A semi-automatic method was implemented for ON segmentation based on T2w as previously described (14). In short, a rough manual contour was used to define a region of interest (ROI) containing each ON.…”

Section: Quantification Of Imaging Markersmentioning

confidence: 99%

“…The CSF object was adjusted by subtraction of the segmented vessel object. Segmentation of Meckel's caves by means of a region-growing algorithm applied to T2w images allowed the calculation of Meckel's cave volume (14). Neighboring voxels of manually selected seed points were iteratively examined and added to the growing object based on intensity similarity criteria.…”

Section: Quantification Of Imaging Markersmentioning

confidence: 99%

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Distorted Optic Nerve Portends Neurological Complications in Infants With External Hydrocephalus

et al. 2021

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Background: Benign external hydrocephalus (BEH) is defined by rapid increase in head circumference in infancy, with neuroimaging evidence of enlarged cerebrospinal fluid (CSF) spaces. BEH was postulated to predispose to subdural hematoma, neurocognitive impairments, and autism. There is currently no consensus on BEH diagnostic criteria and no biomarkers to predict neurological sequalae.Methods: MRI-based quantitative approach was used for measurement of potential imaging markers related to external hydrocephalus and their association with neurological outcomes. We scanned 23 infants diagnosed with BEH and 11 age-similar controls. Using anatomical measurements from a large sample of healthy infants (n = 150), Z-scores were calculated to classify subject's CSF spaces as enlarged (≥1.96SD of mean values) or normal.Results: Subjects with abnormally enlarged CSF spaces had a significantly wider and longer ON (p = 0.017 and p = 0.020, respectively), and a significantly less tortuous ON (p = 0.006). ON deformity demonstrated a high diagnostic accuracy for abnormally enlarged frontal subarachnoid space (AUC = 0.826) and interhemispheric fissure (AUC = 0.833). No significant association found between enlarged CSF spaces and neurological complications (OR = 0.330, 95%CI 0.070–1.553, p = 0.161). However, cluster analysis identified a distinct subgroup of children (23/34, 67.6%) with enlarged CSF spaces and a wider, longer and less tortuous ON, to have an increased risk for neurological complications (RR = 7.28, 95%CI 1.07–49.40).Discussion: This is the first report on the association between external hydrocephalus, ON deformity and neurological complications. Our findings challenge the current view of external hydrocephalus as a benign condition. ON deformity is a potential auxiliary marker for risk stratification in patients with enlarged CSF spaces.

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Interrelation Between Cerebrospinal Fluid Pressure, Intracranial Morphology and Venous Hemodynamics Studied by 4D Flow MRI

Schuchardt,

Krafft,

Miguel Telega

et al. 2024

Clin Neuroradiol

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Purpose To quantify the effects of CSF pressure alterations on intracranial venous morphology and hemodynamics in idiopathic intracranial hypertension (IIH) and spontaneous intracranial hypotension (SIH) and assess reversibility when the underlying cause is resolved. Methods We prospectively examined venous volume, intracranial venous blood flow and velocity, including optic nerve sheath diameter (ONSD) as a noninvasive surrogate of CSF pressure changes in 11 patients with IIH, 11 age-matched and sex-matched healthy controls and 9 SIH patients, before and after neurosurgical closure of spinal dural leaks. We applied multiparametric MRI including 4D flow MRI, time-of-flight (TOF) and T2-weighted half-Fourier acquisition single-shot turbo-spin echo (HASTE). Results Sinus volume overlapped between groups at baseline but decreased after treatment of intracranial hypotension (p = 0.067) along with a significant increase of ONSD (p = 0.003). Blood flow in the middle and dorsal superior sagittal sinus was remarkably lower in patients with higher CSF pressure (i.e., IIH versus controls and SIH after CSF leak closure) but blood flow velocity was comparable cross-sectionally between groups and longitudinally in SIH. Conclusion We were able to demonstrate the interaction of CSF pressure, venous volumetry, venous hemodynamics and ONSD using multiparametric brain MRI. Closure of CSF leaks in SIH patients resulted in symptoms suggestive of increased intracranial pressure and caused a subsequent decrease of intracranial venous volume and of blood flow within the superior sagittal sinus while ONSD increased. In contrast, blood flow parameters from 4D flow MRI did not discriminate IIH, SIH and controls as hemodynamics at baseline overlapped at most vessel cross-sections.

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Quantifying response to intracranial pressure normalization in idiopathic intracranial hypertension via dynamic neuroimaging

Abstract: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:913-927.

Cited by 13 publications

References 33 publications

Clinical Imaging of Choroid Plexus in Health and in Brain Disorders: A Mini-Review

Clinical Imaging of Choroid Plexus in Health and in Brain Disorders: A Mini-Review

Distorted Optic Nerve Portends Neurological Complications in Infants With External Hydrocephalus

Interrelation Between Cerebrospinal Fluid Pressure, Intracranial Morphology and Venous Hemodynamics Studied by 4D Flow MRI

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