Quantitative T1-Kartierung des Cerebrums und quantitative Liquor-Flussmessungen bei Patienten mit idiopathischem Normaldruckhydrozephalus und Idiopathischer Intrakranieller Hypertension

Quantitative cerebral T1 mapping and quantitative CSF flow measurements in patients with idiopathic normal pressure hydrocephalus and idiopathic intracranial hypertension

by Marielle Ruth-Charlot Heide
Doctoral thesis
Date of Examination:2025-04-10
Date of issue:2025-04-03
Advisor:Prof. Dr. Jan Liman
Referee:Prof. Dr. Jan Liman
Referee:Prof. Dr. Christian Riedel
Referee:Prof. Dr. Veit Rohde
Persistent Address: http://dx.doi.org/10.53846/goediss-11180

 

 

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Abstract

English

Idiopathic normal pressure hydrocephalus (iNPH) and idiopathic intracranial hypertension (IIH) are important cerebral disorders with impaired production, circulation or resorption of cerebrospinal fluid (CSF). Despite advances in diagnostic imaging, non-invasive diagnostic tools and disease-specific biomarkers are still rare. In this study, the diagnostic significance of quantitative cerebral T1 mapping and real-time phase contrast measurements of CSF flow as novel and high-resolution magnetic resonance imaging (MRI) techniques were investigated in 15 patients with suspected iNPH and seven patients with suspected IIH and eleven age-matched healthy controls. Measurements were performed using 3T MRI. T1 relaxation times were assessed in five or six predefined periventricular regions. CSF flow measurements were performed at three intracranial and two extracranial measurement regions. MRI as well as clinical and neuropsychological testing were performed prior to and after cerebrospinal fluid tap test (CSF-TT) or lumbar puncture (LP). In our study, periventricular T1 relaxation times were significantly increased in patients with iNPH compared to a healthy control group with most pronounced differences in the anterior (1006 ± 93ms vs. 911 ± 77ms; p= 0.023) and posterior horns (983 ± 103ms vs. 893 ± 68ms; p= 0.037) of the lateral ventricles. Montreal cognitive assessment (MoCA) scores at baseline were negatively correlated with T1 relaxation times (r < –0.5, p < 0.02). Higher T1 relaxation times were significantly correlated with an improvement of the 3-m timed up and go test (r > 0.6 and p < 0.03) after CSF-TT. We found no significant differences in comparing T1 relaxation times before and after the spinal tap test. Apart from increased relaxation times in the superior anterior horn region we found no significant differences in T1 relaxation times in patients with IIH, compared to the control group, and no significant changes after LP. Despite improved MRI methods and taking into account the respiratory influence on CSF pulsation, we did not find any predictive value of total CSF flow volumes determined by real-time phase contrast measurements on clinical improvements after LP in either patient group. The severeness of hydrocephalus in patients with iNPH, quantified by the Evans index, correlated with increased intracranial CSF flow volumes, particularly in the aqueduct and 4th ventricle. However, this had no influence on the results after LP. It can be concluded from our results that T1 mapping represents a new sensitive diagnostic tool for the detection of periventricular tissue changes in iNPH, with a predictive value with regard to an improvement of the gait pattern, in particular gait speed, after the spinal tap test. Analogous findings could not be confirmed in IIH. A conspicuous finding in the superior anterior horn region should be examined in follow-up studies in patients with IIH in earlier stages of the disease, with still elevated CSF pressure.
Keywords: T1 mapping; T1 relaxometry; iNPH; IIH; Gait apraxia; Real-Time MRI