[Idiopathic normal-pressure hydrocephalus. Flow measurement of cerebrospinal fluid using phase contrast MRI and its diagnostics importance]

(Idiopathischer Normaldruckhydrozephalus. Liquorflussmessung mittels Phasenkontrast--RT und ihre diagnostische Bedeutung.)

Full Abstract

AIM:
The measurement of CSF flow in the aqueduct has been a focus of interest since the development of MR imaging (MRI) techniques for this purpose in diagnosing idiopathic normal-pressure hydrocephalus (iNPH).The purpose of this prospective study was to determine the ability of this diagnostic tool to replace invasive methods in establishing the diagnosis of iNPH.

PATIENTS AND METHODS:
Between January 2003 and April 2005, 61 patients with the Hakim triad of clinical symptoms and dilated ventricular systems underwent the intrathecal infusion test, cerebrospinal tap test, and phase-contrast MRI to measure CSF flow rate in the aqueduct. Shunted patients were controlled 12 months postoperatively. Pre- and postoperative clinical symptoms were evaluated with the Kiefer score. Outcome was calculated according to the NPH recovery rate.

RESULTS:
According to these criteria the patients were classified into groups of 41 with iNPH and 20 with brain atrophy. Of the iNPH patients, 39 were shunted and two did not agree to surgery. The mean Kiefer score of the shunted patients was statistically significantly lower after surgery. The aqueductal CSF flow rate of these patients was statistically analyzed and showed that a flow rate of more than 24.5 ml/min is 95% specific to iNPH.

CONCLUSIONS:
Measurement of the CSF flow rate in the aqueduct using phase-contrast MRI is a highly specific preselective method for diagnosing iNPH.

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Author information

Author/s: Al-Zain, F T (FT); Rademacher, G (G); Lemcke, J (J); Mutze, J (J); Meier, U (U);

Affiliation: Klinik für Neurochirurgie, Unfallkrankenhaus Berlin.

Journal and publication information

Publication Type: English Abstract; Journal Article

Journal: Der Nervenarzt (Nervenarzt), published in Germany. (Language: ger)

Reference: 2007-Feb; vol 78 (issue 2) : pp 181-7

Dates: Created 2007/09/24; Completed 2007/11/13;

PMID: 17225144, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Aged
Aged, 80 and over
Cerebral Aqueduct - pathology
Cerebrospinal Fluid - cytology
Female
Humans
Hydrocephalus, Normal Pressure - diagnosis

Hydrocephalus, Normal Pressure - diagnosis
Image Interpretation, Computer-Assisted - methods
Magnetic Resonance Imaging - methods
Male
Middle Aged
Reproducibility of Results
Rheology - methods
Sensitivity and Specificity

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