Evaluation of ventriculomegaly using diffusion tensor imaging: correlations with chronic hydrocephalus and atrophy

Clinical article

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Ventriculomegaly is a common imaging finding in many types of conditions. It is difficult to determine whether it is related to true hydrocephalus or to an atrophic process by using only imaging procedures such as MR imaging after traumatic injury, stroke, or infectious disease. Diffusion tensor (DT) imaging can distinguish the compression characteristics of white matter, indicating that increased diffusion anisotropy may be related to white matter compression. In this preliminary study, the authors compared the DT imaging findings of ventriculomegaly with those of chronic hydrocephalus or atrophy to clarify the potential of diffusion anisotropy in the identification of hydrocephalus.


Ten patients with chronic hydrocephalus, 8 patients with atrophy (defined by conventional devices and surgical outcome), and 14 healthy volunteers underwent DT imaging. Images were acquired before and after shunting or once in cases without shunting. The fractional anisotropy (FA) values at many points around the lateral ventricle were evaluated.


The FA patterns around the lateral ventricle in the chronic hydrocephalus and atrophy groups were different. Especially in the caudate nucleus, FA was increased in the chronic hydrocephalus group compared with the atrophy group. Furthermore, the FA values returned to normal levels after shunt placement.


Assessment of the FA value of the caudate nucleus may be an important, less invasive method for distinguishing true hydrocephalus from ventriculomegaly. Further research in a large number of patients is needed to verify the diagnostic ability of this method.

Abbreviations used in this paper: ant-IC = anterior limb of internal capsule; DT = diffusion tensor; FA = fractional anisotropy; FSE = fast spin echo; ICH = intracranial hemorrhage; ICP = intracranial pressure; iNPH = idiopathic normal-pressure hydrocephalus; MD = mean diffusivity; post-IC = posterior limb of the internal capsule; PVH = periventricular hyperintensity; SAH = subarachnoid hemorrhage; VOI = volume of interest.

Article Information

Address correspondence to: Eiichi Ishikawa, M.D., Ph.D., Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan. email: e-ishikawa@md.tsukuba.ac.jp.

Please include this information when citing this paper: published online August 21, 2009; DOI: 10.3171/2009.7.JNS09550.

© AANS, except where prohibited by US copyright law.



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    Case 5. Representative VOI selection in a patient. The head of the caudate nucleus (b), the thalamus (e), and the ant-IC (c) and post-IC (d) were selected in an axial color-coded map (A) and FA map (B). The corpus callosum was selected using a median section of a sagittal color-coded map; it was marked in red. The splenium (f), anterior third of the body (g), posterior third of the body (h), and genu (i) were chosen in a sagittal color-coded map (C). The periventricular part of the corona radiata (j) was selected as the blue area on the median section of a coronal color-coded map (D). The periventricular frontal white matter (a) was chosen on a high-intensity area on an FSE T2-weighted MR image (E).

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    Bar graph showing the mean FA values for each point in preoperative studies in the chronic hydrocephalus, atrophy, and control groups. In the chronic hydrocephalus group, some regions (all points of the corpus callosum and periventricular white matter) indicated remarkably decreased values of FA. Only in the caudate nucleus did the FA value increase with statistical significance. *p < 0.05, Mann-Whitney test. Body-1 and Body-2 indicate, respectively, the anterior third and posterior third of the body of the corpus callosum.

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    Bar graph demonstrating the mean preoperative and postoperative FA values for each point in the chronic hydrocephalus group. The FA value of some points (ant-IC, post-IC, corona radiata, and caudate nucleus) decreased after the operation. Only the decrease in the FA value of the caudate nucleus was statistically significant. On the other hand, the corpus callosum and periventricular white matter were characterized by increased FA after shunt placement. The FA value of the thalamus had no remarkable change. *p < 0.05, Wilcoxon test.

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    Graph showing all detailed FA values of the caudate nucleus in a comparison among the 3 groups. The FA value of the caudate nucleus increased in most patients with chronic hydrocephalus compared with that in both the atrophy and control groups. The FA values were decreased in the hydrocephalus group after shunt surgery.


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