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Sung Ho, J.; Cho, M.J. Diffusion Tensor Imaging for Hydrocephalus in Stroke. Encyclopedia. Available online: https://encyclopedia.pub/entry/23753 (accessed on 17 July 2025).
Sung Ho J, Cho MJ. Diffusion Tensor Imaging for Hydrocephalus in Stroke. Encyclopedia. Available at: https://encyclopedia.pub/entry/23753. Accessed July 17, 2025.
Sung Ho, Jang, Min Jye Cho. "Diffusion Tensor Imaging for Hydrocephalus in Stroke" Encyclopedia, https://encyclopedia.pub/entry/23753 (accessed July 17, 2025).
Sung Ho, J., & Cho, M.J. (2022, June 06). Diffusion Tensor Imaging for Hydrocephalus in Stroke. In Encyclopedia. https://encyclopedia.pub/entry/23753
Sung Ho, Jang and Min Jye Cho. "Diffusion Tensor Imaging for Hydrocephalus in Stroke." Encyclopedia. Web. 06 June, 2022.
Diffusion Tensor Imaging for Hydrocephalus in Stroke
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This entry is adapted from the peer-reviewed paper 10.3390/diagnostics12061314

Hydrocephalus is a dilatation of the brain ventricular system by the accumulation of cerebrospinal fluid within the ventricle caused by impaired cerebrospinal fluid circulation or clearance.

hydrocephalus diffusion tensor imaging stroke shunt

1. Introduction

Hydrocephalus is a dilatation of the brain ventricular system caused by the accumulation of cerebrospinal fluid within the ventricle from impaired cerebrospinal fluid circulation or clearance [1][2][3][4][5]. This excessive cerebrospinal fluid increases pressure on the periventricular neural structures. Consequently, acute hydrocephalus could cause various clinical symptoms including headaches, vomiting, nausea, sleepiness, coma, papilledema, and diplopia [6]. By contrast, chronic or normal pressure hydrocephalus is accompanied by various clinical features, including the clinical triad (gait disturbance, cognitive impairment, and urinary incontinence) [1][2][3][4][5][7][8]. The diagnosis of hydrocephalus at the chronic stage of stroke has generally been made mainly by clinical features and radiologic findings (computed tomography (CT) and conventional magnetic resonance imaging (MRI)) [1][2][3][5][7][9][10]. Although measurements of the relative ventricular size have been used as an objective evaluation tool for the radiology findings, it could not precisely determine the effect of hydrocephalus on the periventricular neural structures [9][11]. Furthermore, the effects of surgical interventions for hydrocephalus on the periventricular neural structures also could not be determined precisely.
Diffusion tensor imaging (DTI), which generates images based on estimations of the diffusion characteristics of water molecules in the brain microstructures, has enabled an evaluation of the microstructural features of the white matter [12][13]. As a result, DTI can estimate the effects of the hydrocephalus or surgical interventions for hydrocephalus on the periventricular white matter or neural structures using DTI parameters [5][8][14][15]. DTI parameters are measured using region of interest (ROI) methods for specific neural areas or an analysis of the whole subcortical white matter using specific analysis programs, such as tract-based spatial statistics [12][13][16]. By contrast, the neural tracts can be reconstructed three-dimensionally using diffusion tensor tractography (DTT) reconstructed based on DTI data [17][18][19][20]. The main advantage of DTT is that the entire neural tract can be evaluated from DTT parameters and configurational analysis (integrity and configuration) [17][18][20]. Consequently, the effects of the hydrocephalus or surgical interventions for hydrocephalus on the periventricular neural tracts or structures can be estimated using DTT [21][22][23][24][25][26]. Fractional anisotropy (FA: the state of white matter organization because it is a measure of the degree of directionality and integrity of the white matter microstructures), apparent diffusion coefficient (or mean diffusivity)(the magnitude of water diffusion), and tract volume (or fiber number; the number of voxels within a neural tract which represents the number of fibers within of a neural tract) have been commonly used as DTI or DTT parameters [12][13][17][18][20]. As a result, DTI or DTT for periventricular white matter or neural structures have been suggested as a non-invasive tool for evaluating the presence, severity, and shunt effect of hydrocephalus in stroke patients [4][8][14][15][21][22][23][24][25][26].

2. Role of Diffusion Tensor Imaging in the Diagnosis of Hydrocephalus in Stroke Patients

In 2010, Osuka et al. examined whether ventromegaly is related to true hydrocephalus or brain atrophy in patients who exhibited ventromegaly after brain injury [8]. Ten patients with chronic hydrocephalus (eight with subarachnoid hemorrhage (SAH) and two with idiopathic normal pressure hydrocephalus) and eight patients with brain atrophy were recruited. All patients with chronic hydrocephalus showed improvement of the clinical features of hydrocephalus after ventriculoperitoneal or lumboperitoneal shunt surgery. The FA values were measured in 10 ROIs in the periventricular areas: the corpus callosum (the splenium, anterior third of the body, posterior third of the body, and genu), caudate nucleus, thalamus, anterior and posterior limbs of the internal capsule, the periventricular corona radiata, and high-intensity area in the periventricular frontal white matter. Only the FA value of the caudate nucleus was higher in the hydrocephalus group than in both the atrophy and normal control groups. The researchers attributed the increased FA value in the caudate nucleus to tissue compression by the hydrocephalus [4][14][15][19]. The FA value of the caudate nucleus decreased in all patients in the hydrocephalus group cases after shunt surgery. By contrast, inconsistent results were observed in the other ROIs. As a result, the researchers concluded that the FA value of the caudate nucleus could be a diagnostic biomarker for differentiating true hydrocephalus from brain atrophy. To the best of the researchers’ knowledge, this is the first research to demonstrate the role of DTI in the diagnosis of hydrocephalus in stroke patients. On the other hand, the heterogeneous brain pathologies of the recruited patients were a limitation of this research. This research was classified as the diagnosis part of this research because the researchers focused on the diagnostic utility of DTI, even though this research included DTI data after shunt surgery [8].
In 2013, Jang et al. investigated the effects of hydrocephalus on the neural structures in the periventricular area in 14 patients diagnosed with hydrocephalus after a spontaneous intracerebral hemorrhage (ICH) [15]. DTI was scanned at the chronic stage of ICH (5–52 weeks after onset) and DTI parameters were estimated in the six ROIs: the anterior corona radiata, posterior corona radiata, genu of the corpus callosum, splenium of the corpus callosum, anterior limb of the internal capsule, and posterior limb of the internal capsule. The FA value increased only in the anterior corona radiata without changes in the other ROIs and apparent diffusion coefficient values. The researchers assumed that an increase in FA value in the anterior corona radiata indicated greater fiber packing caused by mechanical pressure in this area by the hydrocephalus [8][15][19]. On the other hand, the researchers measured the relative width ratios between the maximum distance of the ventricular walls and the maximum width of the brain at the anterior horn, ventricular body, and posterior horn of the lateral ventricle [9][11]. The patient group showed higher relative width ratios in three areas than the control group. In particular, the relative width ratios of the anterior horn were increased more than the other relative width ratios. As a result, the researchers concluded that in patients with hydrocephalus following ICH, the anterior corona radiata was compressed more by hydrocephalus than the other neural structures of the periventricular area [4][8][12][13][14][15]. They suggested that the FA value of the anterior periventricular corona radiata could provide an important diagnostic clue for hydrocephalus. The advantage of this research was that the researchers suggested a pathophysiological mechanism for the clinical features of hydrocephalus related to a frontal lobe dysfunction, such as gait disturbance, cognitive impairment, and urinary incontinence [27][28][29]. Nevertheless, this research was limited by the small number of subjects.
In 2016, Jang and Lee examined the utility of the distance between corticospinal tracts on DTT as a diagnostic biomarker for hydrocephalus in stroke patients [21]. Fifteen patients who underwent shunt surgery for hydrocephalus that developed after spontaneous intraventricular hemorrhage (IVH) were recruited. DTI scanning was performed at the chronic stage (more than one month after onset and before shunt surgery). The researchers measured two types of distances on the axial slice of the corona radiata level, which was the widest distance between the corticospinal tracts: the absolute distance (between the most medial point of both corticospinal tracts in the mediolateral horizontal direction) and the relative distance (absolute distance divided by the distance between both lateral margins of the brain at the same horizontal line of both corticospinal tracts on the same axial image). Both absolute and relative distances or the corticospinal tracts were higher in the patient group than in the normal control group. The researchers suggested that the absolute and relative distances of the corticospinal tracts on DTT could be a diagnostic biomarker of hydrocephalus because the corticospinal tract descended bilaterally through the corona radiata which could easily be affected by hydrocephalus [30]. Therefore, the advantage of this research was that the researchers suggested that the distance of the neural tracts in the periventricular white matter could be a diagnostic biomarker for hydrocephalus and ventricular size. On the other hand, the researchers did not report the real effect of hydrocephalus on the corticospinal tracts using DTI parameters. Furthermore, they did not compare the diagnostic value with the ventricular size currently used as a diagnostic biomarker for hydrocephalus [9][11].

References

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