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. 2022 Sep 1;19(1):66.
doi: 10.1186/s12987-022-00362-8.

Distinct volumetric features of cerebrospinal fluid distribution in idiopathic normal-pressure hydrocephalus and Alzheimer's disease

Jaehwan Han  1 , Myoung Nam Kim  1 , Ho-Won Lee  2   3 , Shin Young Jeong  4 , Sang-Woo Lee  4 , Uicheul Yoon  5 , Kyunghun Kang  6
Affiliations

Distinct volumetric features of cerebrospinal fluid distribution in idiopathic normal-pressure hydrocephalus and Alzheimer's disease

Jaehwan Han et al. Fluids Barriers CNS. .

Abstract

Objective: The aims of the study were to measure the cerebrospinal fluid (CSF) volumes in the lateral ventricle, high-convexity subarachnoid space, and Sylvian fissure region in patients with idiopathic normal-pressure hydrocephalus (INPH) and Alzheimer's disease (AD), and to evaluate differences in these volumes between INPH and AD groups and healthy controls.

Methods: Forty-nine INPH patients, 59 AD patients, and 26 healthy controls were imaged with automated three-dimensional volumetric MRI.

Results: INPH patients had larger lateral ventricles and CSF spaces of the Sylvian fissure region and smaller high-convexity subarachnoid spaces than other groups, and AD patients had larger lateral ventricles and CSF spaces of the Sylvian fissure region than the control group. The INPH group showed a negative correlation between lateral ventricle and high-convexity subarachnoid space volumes, while the AD group showed a positive correlation between lateral ventricle volume and volume for CSF spaces of the Sylvian fissure region. The ratio of lateral ventricle to high-convexity subarachnoid space volumes yielded an area under the curve of 0.990, differentiating INPH from AD.

Conclusions: Associations between CSF volumes suggest that there might be different mechanisms between INPH and AD to explain their respective lateral ventricular dilations. The ratio of lateral ventricle to high-convexity subarachnoid space volumes distinguishes INPH from AD with good diagnostic sensitivity and specificity. We propose to refer to this ratio as the VOSS (ventricle over subarachnoid space) index.

Keywords: Alzheimer’s disease; Cerebrospinal fluid space; Idiopathic normal-pressure hydrocephalus; Magnetic resonance imaging.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
The processes to investigate volume of CSF spaces, including the high-convexity subarachnoid space and CSF spaces of the Sylvian fissure region. Individual CSF images were segmented from 3D-T1-weighted images. Two regions of interest (ROIs) were created for the high-convexity area (blue) and Sylvian fissure region (red), and these ROIs defined by Talairach grid divisions were shown in the ICBM 152 stereotaxic space
Fig. 2
Fig. 2
Box and whisker plots of the normalized volumes for lateral ventricles, high-convexity subarachnoid space, and CSF spaces of the Sylvian fissure region for three groups. Normalized CSF space volumes were expressed as regional volume/intracranial volume
Fig. 3
Fig. 3
Relationship between normalized lateral ventricle volume and normalized volume for high-convexity subarachnoid space and normalized volume for CSF spaces of the Sylvian fissure region in patients with INPH and AD. Normalized CSF space volumes were expressed as regional volume/intracranial volume. Blue dots represent INPH subjects while red dots represent AD subjects
Fig. 4
Fig. 4
Receiver operating characteristic (ROC) curve in classifying INPH patients and AD patients using lateral ventricle volume/high-convexity subarachnoid space volume ratio
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