Changes in sensorimotor-related thalamic diffusion properties and cerebrospinal fluid hydrodynamics predict gait responses to tap test in idiopathic normal-pressure hydrocephalus

Ping Huei Tsai, Yung Chieh Chen, Shih Wei Chiang, Teng Yi Huang, Ming Chung Chou, Hua Shan Liu, Hsiao Wen Chung, Giia Sheun Peng, Hsin I. Ma, Hung Wen Kao, Cheng Yu Chen

Research output: Contribution to journalArticle

Abstract

Objectives: To compare diffusion tensor (DT)-derived indices from the thalamic nuclei and cerebrospinal fluid (CSF) hydrodynamic parameters for the prediction of gait responsiveness to the CSF tap test in early iNPH patients. Methods: In this study, 22 patients with iNPH and 16 normal controls were enrolled with the approval of an institutional review board. DT imaging and phase-contrast magnetic resonance imaging were performed in patients and controls to determine DT-related indices of the sensorimotor-related thalamic nuclei and CSF hydrodynamics. Gait performance was assessed in patients using gait scale before and after the tap test. The Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were applied to compare group differences between patients and controls and assess the predictive performance of gait responsiveness to the tap test in the patients. Results: Fractional anisotropy (FA) and axial diffusivity showed significant increases in the ventrolateral (VL) and ventroposterolateral (VPL) nuclei of the iNPH group compared with those of the control group (p < 0.05). The predictions of gait responsiveness of ventral thalamic FA alone (area under the ROC curve [AUC] < 0.8) significantly outperformed those of CSF hydrodynamics alone (AUC < 0.6). The AUC curve was elevated to 0.812 when the CSF peak systolic velocity and FA value were combined for the VPL nucleus, yielding the highest sensitivity (0.769) and specificity (0.778) to predict gait responses. Conclusions: Combined measurements of sensorimotor-related thalamic FA and CSF hydrodynamics can provide potential biomarkers for gait response to the CSF tap test in patients with iNPH. Key Points: • Ventrolateral and ventroposterolateral thalamic FA may predict gait responsiveness to tap test.• Thalamic neuroplasticity can be assessed through DTI in idiopathic normal-pressure hydrocephalus.• Changes in the CST associated with gait control could trigger thalamic neuroplasticity.• Activities of sensorimotor-related circuits could alter in patients with gait disturbance.• Management of patients with iNPH could be more appropriate.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalEuropean Radiology
DOIs
Publication statusAccepted/In press - May 7 2018

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Normal Pressure Hydrocephalus
Hydrodynamics
Gait
Cerebrospinal Fluid
Anisotropy
ROC Curve
Thalamic Nuclei
Neuronal Plasticity
Area Under Curve
Diffusion Tensor Imaging
Research Ethics Committees
Nonparametric Statistics
Biomarkers
Magnetic Resonance Imaging

Keywords

  • Diffusion tensor imaging
  • Gait
  • Hydrocephalus, normal pressure
  • Neuronal plasticity
  • Thalamus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Changes in sensorimotor-related thalamic diffusion properties and cerebrospinal fluid hydrodynamics predict gait responses to tap test in idiopathic normal-pressure hydrocephalus. / Tsai, Ping Huei; Chen, Yung Chieh; Chiang, Shih Wei; Huang, Teng Yi; Chou, Ming Chung; Liu, Hua Shan; Chung, Hsiao Wen; Peng, Giia Sheun; Ma, Hsin I.; Kao, Hung Wen; Chen, Cheng Yu.

In: European Radiology, 07.05.2018, p. 1-10.

Research output: Contribution to journalArticle

Tsai, Ping Huei ; Chen, Yung Chieh ; Chiang, Shih Wei ; Huang, Teng Yi ; Chou, Ming Chung ; Liu, Hua Shan ; Chung, Hsiao Wen ; Peng, Giia Sheun ; Ma, Hsin I. ; Kao, Hung Wen ; Chen, Cheng Yu. / Changes in sensorimotor-related thalamic diffusion properties and cerebrospinal fluid hydrodynamics predict gait responses to tap test in idiopathic normal-pressure hydrocephalus. In: European Radiology. 2018 ; pp. 1-10.
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AU - Tsai, Ping Huei

AU - Chen, Yung Chieh

AU - Chiang, Shih Wei

AU - Huang, Teng Yi

AU - Chou, Ming Chung

AU - Liu, Hua Shan

AU - Chung, Hsiao Wen

AU - Peng, Giia Sheun

AU - Ma, Hsin I.

AU - Kao, Hung Wen

AU - Chen, Cheng Yu

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N2 - Objectives: To compare diffusion tensor (DT)-derived indices from the thalamic nuclei and cerebrospinal fluid (CSF) hydrodynamic parameters for the prediction of gait responsiveness to the CSF tap test in early iNPH patients. Methods: In this study, 22 patients with iNPH and 16 normal controls were enrolled with the approval of an institutional review board. DT imaging and phase-contrast magnetic resonance imaging were performed in patients and controls to determine DT-related indices of the sensorimotor-related thalamic nuclei and CSF hydrodynamics. Gait performance was assessed in patients using gait scale before and after the tap test. The Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were applied to compare group differences between patients and controls and assess the predictive performance of gait responsiveness to the tap test in the patients. Results: Fractional anisotropy (FA) and axial diffusivity showed significant increases in the ventrolateral (VL) and ventroposterolateral (VPL) nuclei of the iNPH group compared with those of the control group (p < 0.05). The predictions of gait responsiveness of ventral thalamic FA alone (area under the ROC curve [AUC] < 0.8) significantly outperformed those of CSF hydrodynamics alone (AUC < 0.6). The AUC curve was elevated to 0.812 when the CSF peak systolic velocity and FA value were combined for the VPL nucleus, yielding the highest sensitivity (0.769) and specificity (0.778) to predict gait responses. Conclusions: Combined measurements of sensorimotor-related thalamic FA and CSF hydrodynamics can provide potential biomarkers for gait response to the CSF tap test in patients with iNPH. Key Points: • Ventrolateral and ventroposterolateral thalamic FA may predict gait responsiveness to tap test.• Thalamic neuroplasticity can be assessed through DTI in idiopathic normal-pressure hydrocephalus.• Changes in the CST associated with gait control could trigger thalamic neuroplasticity.• Activities of sensorimotor-related circuits could alter in patients with gait disturbance.• Management of patients with iNPH could be more appropriate.

AB - Objectives: To compare diffusion tensor (DT)-derived indices from the thalamic nuclei and cerebrospinal fluid (CSF) hydrodynamic parameters for the prediction of gait responsiveness to the CSF tap test in early iNPH patients. Methods: In this study, 22 patients with iNPH and 16 normal controls were enrolled with the approval of an institutional review board. DT imaging and phase-contrast magnetic resonance imaging were performed in patients and controls to determine DT-related indices of the sensorimotor-related thalamic nuclei and CSF hydrodynamics. Gait performance was assessed in patients using gait scale before and after the tap test. The Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were applied to compare group differences between patients and controls and assess the predictive performance of gait responsiveness to the tap test in the patients. Results: Fractional anisotropy (FA) and axial diffusivity showed significant increases in the ventrolateral (VL) and ventroposterolateral (VPL) nuclei of the iNPH group compared with those of the control group (p < 0.05). The predictions of gait responsiveness of ventral thalamic FA alone (area under the ROC curve [AUC] < 0.8) significantly outperformed those of CSF hydrodynamics alone (AUC < 0.6). The AUC curve was elevated to 0.812 when the CSF peak systolic velocity and FA value were combined for the VPL nucleus, yielding the highest sensitivity (0.769) and specificity (0.778) to predict gait responses. Conclusions: Combined measurements of sensorimotor-related thalamic FA and CSF hydrodynamics can provide potential biomarkers for gait response to the CSF tap test in patients with iNPH. Key Points: • Ventrolateral and ventroposterolateral thalamic FA may predict gait responsiveness to tap test.• Thalamic neuroplasticity can be assessed through DTI in idiopathic normal-pressure hydrocephalus.• Changes in the CST associated with gait control could trigger thalamic neuroplasticity.• Activities of sensorimotor-related circuits could alter in patients with gait disturbance.• Management of patients with iNPH could be more appropriate.

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