Quantification of changes in white matter tract fibers in idiopathic normal pressure hydrocephalus based on diffusion spectrum imaging.

PURPOSE:Patients with idiopathic normal pressure hydrocephalus (iNPH) present white-matter abnormalities. The analytical methods described to date only measure mean diffusion parameter alterations of iNPH-specific brain regions or in a certain fasciculus. This study quantitatively analyzed whether iNPH-tract abnormalities are confined to specific sections or involve entire fibers based on diffusion spectrum imaging (DSI). METHOD:Twenty-two patients with iNPH and 20 normally aging subjects were included. The 18 main tracts in the brain of each subject were extracted, and the diffusion parameters of 100 equidistant nodes on each fiber were calculated to quantitatively evaluate integrity changes in different regions along these tracts. Two diffusion metrics were measured, i.e., general fractional anisotropy (GFA) and fractional anisotropy (FA). RESULTS:Compared to normally aging (P < 0.05), in iNPH, the GFA and FA of the left uncinate fasciculus and FA of the bilateral superior longitudinal fasciculus 1 were reduced in areas where the entire fiber was involved (%nodes with significant differences > 90%). Most other fasciculi detected presented GFA or FA alterations limited to specific regions. Increased and decreased GFA or FA co-occurred in different sections of the same fibers, including the corticospinal tract and left thalamic radiation posterior in iNPH. CONCLUSIONS:Few iNPH fibers presented diffusion abnormalities involving nearly all tracts. Most fiber abnormalities in iNPH were confined to specific areas, and different parts of the same fasciculus showed diverse diffusion alterations in few cases. This DSI-based tract analysis provided detailed information on iNPH white-matter changes.