Quantitative analysis of cerebrospinal fluid dynamics at phase contrast cine-MRI: predictivity of neurosurgical “Shunt” responsiveness in patients with idiopathic normal pressure hydrocephalus.
Autor: Stecco, Alessandro; Cassarà, Alessia; Zuccalà, Alberto; Anoaica, Mihaela B.; Genovese, Egidio; Car, Pier G.; Panzarasa, Gabriele P.; Guzzardi, Giuseppe; Carriero, Alessandro
Publication year: 2020
Journal of neurosurgical sciences
issn:1827-1855 0390-5616
doi: 10.23736/S0390-5616.17.04092-9
Abstract:
BACKGROUND: Aqueductal stroke volume (ACSV) measured by phase-contrast cine (PCC)-MRI has been proposed with controversy as a tool for the selection of patients with normal pressure hydrocephalus (NPH) as candidates for shunt-surgery. The aim of this study was to assess if PCC-MRI scan measurements of ACSV could select properly these patients. METHODS: We retrospectively reviewed charts and MRI of 38 shunted patients (72.16±6.16 years). ACSV measurements were performed 7-30 days before shunt and at the first and sixth months after surgery. Normally distributed variables were compared in the two groups (improved/unimproved) by t-test for baseline values and with repeated measures analysis of variance. RESULTS: Twenty-six patients (68,4%) improved after VPS (mean time of symptom onset was 8.15±7.19 months). Mean preoperative ACSV value was 271.85±143.03, which decreased by 21.6% (mean 213±125.14) at the first month and 40.3% sixth months after VPS (mean 162.15±91.5). Twelve patients (31.6%) did not improve (mean time of symptom onset was 29±5.62 months). Mean preoperative ACSV value was 79.83±31.24, decreased to 8.7% (mean 72.83±28.66) at first month after VPS. 21.2% (mean 62.83±31.12) after six months. We found statistical difference between preoperative ACSV of improved and unimproved patients (P<0.01), onset time of symptoms (P<0.01) and the changes in ACSV after one and six months in both groups (P<0.001). CONCLUSIONS: ACSV is useful to stratify patients with NPH after surgery (improved /not improved) suggesting to proceed with serial ACSV measurements before deciding treatment. Language: eng Rights: Pmid: 28869371 Tags: Humans; Retrospective Studies; Treatment Outcome; *Magnetic Resonance Imaging; *Hydrocephalus; *Hydrocephalus, Normal Pressure/diagnostic imaging/therapy; Cerebral Aqueduct; Cerebrospinal Fluid Link: https://pubmed.ncbi.nlm.nih.gov/28869371/
