Width of 3. Ventricle: Reference Values and Clinical Relevance in a Cohort of Patients with Relapsing Remitting Multiple Sclerosis

Abstract

Objectives:To estimate the quantity of multiple sclerosis (MS) patients with brain atrophy as indicated by third ventricular enlargement using transcranial colourcoded ultrasound (TCCS).Methods:The width of the 3. ventricle was assessed by TCCS in 70 healthy controls (male 31, female 39, mean age 41 ± 15 years, age range 18 – 79 years), and in a cohort of 54 patients with relapsing remitting MS (male 16, female 38, mean age 40 ± 10 years, median EDSS 2 [1-3]). Results:In the controls, the width of the 3. ventricle increased with age (without any sex differences) from 3.0 ± 0.76 mm in the age group < 40 years to 4.0 ± 0.74 mm in the age group of 60 years or more (ANOVA p=0.0001). Derived from regression analysis, the upper limit of the 95% Confidence Interval for each year provided cutoff points according to which 14 of 54 patients (25%) exhibited an enlarged 3. ventricle. In a multivariate regression analysis, the width of the 3. ventricle over all MS patients was significantly related to EDSS (Spearman rho , r=0.446, p<0.005) and to MS duration (r=0.319, p<0.005). Conclusions:Even in MS patients in good clinical conditions the rate of patients with brain atrophy determined by TCCS is high.

Third ventricular enlargement in early stages of multiple sclerosis is a predictor of motor and neuropsychological deficits: a cross-sectional study

“…The ultrasound investigations were performed by MM and JV. The interobserver agreement17 in assessing third ventricular width showed a coefficient of determination of R 2 =0.97. Using Bland-and-Altman-Plot statistics, the mean of the interobserver difference was 0.24 mm with the 1.96 SD boundaries at 1.06 and −0.56 mm, indicating that interobserver variability in assessing third ventricle width lies well under 1 mm.…”

“…The study population (patients and controls) has been described in detail in a previous report in which the focus was firmly laid on the methodological approach of ultrasound examination 17. In this report, we focus on the neuropsychological findings.…”

Central Atrophy Early in Multiple Sclerosis: Third Ventricle Volumetry versus Planimetry

“…A decrease in brain parenchymal volume is accompanied by a corresponding increase in the volume of inner and outer cerebral spinal fluid (CSF) spaces, the latter being visually noticed by a widening of the ventricular system, described by the term central atrophy. Ventricular enlargement in MS is well studied, [7][8][9][10][11][12][13] ranging from global assessment of the full amount of CSF spaces to selective regional measures such as the width of the third or fourth ventricle. [7][8][9]12 The width of the third ventricle (3VW) has been suggested as a reliable marker for central brain atrophy quantification using either MRI or transcranial sonography, showing an association with clinical, and moreover, cognitive dysfunction in MS. 7,14 Lateral ventricle volume and 3VW were found to be sensitive measures, clearly distinguishing patients with early MS from controls.…”

Width of The Third Ventricle as Assessed by Transcranial Sonography is Associated with Future Relapses in Mild Multiple Sclerosis

“…The width of the 3rd ventricle was assessed as the minimum distance between the inner boundaries of both hyperechogenic lines when displayed strictly parallel. For this approach, we previously reported a highly reliable interobserver agreement with an R 2 of 0.97 and an interobserver variability in assessing the 3rd ventricle width well less than 1 mm [13]. In this previous report, we had included our control population consisting of 70 healthy subjects (31 men, 39 women; mean age 41 ± 15 years; age range 18-79 years); their mean 3 rd ventricular width was 3.4 ± 0.80 mm.…”

“…TCS is examiner-dependent, which could explain the variability in 3rd ventricle reference values established by different working groups [6,[13][14][15][16]. For similar reasons, ventricle widths measured with TCS cannot simply be transferred to MRI measurements [6,17].…”