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Eklund, Anders
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Ryska, P., Slezak, O., Eklund, A., Malm, J., Salzer, J. & Zizka, J. (2020). Radiological markers of idiopathic normal pressure hydrocephalus: Relative comparison of their diagnostic performance. Journal of the Neurological Sciences, 408, Article ID 116581.
Open this publication in new window or tab >>Radiological markers of idiopathic normal pressure hydrocephalus: Relative comparison of their diagnostic performance
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2020 (English)In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 408, article id 116581Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Numerous radiological measures have been proposed as imaging biomarkers of idiopathic normal pressure hydrocephalus (iNPH), however, the number of studies systematically comparing their diagnostic values remains limited. The study objective was to compare the diagnostic performance of fifteen cross-sectional imaging iNPH biomarkers.

MATERIALS AND METHODS: Eighty subjects were prospectively enrolled in the study: 35 subjects with clinically confirmed iNPH and 45 matched healthy controls (HC). Values of linear, angular and index measurements including three newly proposed biomarkers were obtained from 3T brain MRI studies by two independent readers. Diagnostic performance of biomarkers was studied by using receiver operating characteristic (ROC) analysis and t-statistic.

RESULTS: All biomarkers studied were able to reliably differentiate iNPH subjects from HC (p < .001) except for cella media-to-temporal horn ratio. Z-Evans index, vertical cella media and vertical frontal horn diameters showed the highest discriminatory power between iNPH and HC groups (area under curve >0.99). Simple linear measurements of vertical (0.99) or horizontal (0.95) frontal horn diameters showed results comparable to calculated ratios, i.e. z-Evans (0.99) and Evans (0.96) indexes, respectively.

CONCLUSION: The best diagnostic performance among fifteen radiological iNPH biomarkers was found in linear measurements referring to caudocranial alterations of the ventricular geometry, outweighing those referring to laterolateral ventricular enlargement (as e.g. commonly used Evans index). Simple linear measurements of vertical or horizontal frontal horn diameters showed comparable results to calculated, more time-consuming z-Evans or Evans indexes, respectively.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Dementia, Diagnostic performance, Discriminatory power, Imaging biomarker, Magnetic resonance imaging, Normal pressure hydrocephalus (NPH)
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:umu:diva-167288 (URN)10.1016/j.jns.2019.116581 (DOI)31760225 (PubMedID)
Available from: 2020-01-15 Created: 2020-01-15 Last updated: 2020-01-17Bibliographically approved
Gasslander, J., Sundström, N., Eklund, A., Koskinen, L.-O. D. & Malm, J. (2020). Risk factors for developing subdural hematoma: a registry-based study in 1457 patients with shunted idiopathic normal pressure hydrocephalus. Journal of Neurosurgery, 1-10
Open this publication in new window or tab >>Risk factors for developing subdural hematoma: a registry-based study in 1457 patients with shunted idiopathic normal pressure hydrocephalus
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2020 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, p. 1-10Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: Subdural hematomas and hygromas (SDHs) are common complications in idiopathic normal pressure hydrocephalus (iNPH) patients with shunts. In this registry-based study, patients with shunted iNPH were screened nationwide to identify perioperative variables that may increase the risk of SDH.

METHODS: The Swedish Hydrocephalus Quality Registry was reviewed for iNPH patients who had undergone shunt surgery in Sweden in 2004-2014. Potential risk factors for SDH were recorded preoperatively and 3 months after surgery. Drug prescriptions were identified from a national pharmacy database. Patients who developed SDHs were compared with those without SDHs.

RESULTS: The study population consisted of 1457 patients, 152 (10.4%) of whom developed an SDH. Men developed an SDH more often than women (OR 2.084, 95% CI 1.421-3.058, p < 0.001). Patients on platelet aggregation inhibitors developed an SDH more often than those who were not (OR 1.733, 95% CI 1.236-2.431, p = 0.001). At surgery, shunt opening pressures had been set 5.9 mm H2O lower in the SDH group than in the no-SDH group (109.6 ± 24.1 vs 115.5 ± 25.4 mm H2O, respectively, p = 0.009). Antisiphoning devices (ASDs) were used in 892 patients but did not prevent SDH. Mean opening pressures at surgery and the follow-up were lower with shunts with an ASD, without causing more SDHs. No other differences were seen between the groups.

CONCLUSIONS: iNPH patients in this study were diagnosed and operated on in routine practice; thus, the results represent everyday care. Male sex, antiplatelet medication, and a lower opening pressure at surgery were risk factors for SDH. Physical status and comorbidity were not. ASD did not prevent SDH, but a shunt with an ASD allowed a lower opening pressure without causing more SDHs.

Keywords
hydrocephalus; normal pressure, hygroma, chronic subdural hematoma, cerebrospinal shunt, complications
National Category
Neurology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:umu:diva-167468 (URN)10.3171/2019.10.JNS191223 (DOI)31923893 (PubMedID)
Note

Abbreviations: ASD = antisiphoning device; CSF = cerebrospinal fluid; iNPH = idiopathic normal pressure hydrocephalus; NSAID = nonsteroidal anti-inflammatory drug; SDH = subdural hematoma/hygroma; SHQR = Swedish Hydrocephalus Quality Registry; SPDR = Swedish Prescribed Drug Register.

Available from: 2020-01-22 Created: 2020-01-22 Last updated: 2020-01-24
Dunås, T., Wåhlin, A., Zarrinkoob, L., Malm, J. & Eklund, A. (2019). 4D flow MRI: automatic assessment of blood flow in cerebral arteries. Biomedical Physics & Engineering Express, 5(1), Article ID 015003.
Open this publication in new window or tab >>4D flow MRI: automatic assessment of blood flow in cerebral arteries
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2019 (English)In: Biomedical Physics & Engineering Express, ISSN 2057-1976, Vol. 5, no 1, article id 015003Article in journal (Refereed) Published
Abstract [en]

Objective: With a 10-minute 4D flow MRI scan, the distribution of blood flow to individual arteries throughout the brain can be analyzed. This technique has potential to become a biomarker for treatment decisions, and to predict prognosis after stroke. To efficiently analyze and model the large dataset in clinical practice, automatization is needed. We hypothesized that identification of selected arterial regions using an atlas with a priori probability information on their spatial distribution can provide standardized measurements of blood flow in the main cerebral arteries.

Approach: A new method for automatic placement of measurement locations in 4D flow MRI was developed based on an existing atlas-based method for arterial labeling, by defining specific regions of interest within the corresponding arterial atlas. The suggested method was evaluated on 38 subjects with carotid artery stenosis, by comparing measurements of blood flow rate at automatically selected locations to reference measurements at manually selected locations.

Main results: Automatic and reference measurement ranged from 10 to 580 ml min−1 and were highly correlated (r = 0.99) with a mean flow difference of 0.61 ± 10.7 ml min−1 (p = 0.21). Out of the 559 arterial segments in the manual reference, 489 were correctly labeled, yielding a sensitivity of 88%, a specificity of 85%, and a labeling accuracy of 87%.

Significance: This study confirms that atlas-based labeling of 4D flow MRI data is suitable for efficient flow quantification in the major cerebral arteries. The suggested method improves the feasibility of analyzing cerebral 4D flow data, and fills a gap necessary for implementation in clinical use.

Place, publisher, year, edition, pages
Institute of Physics Publishing (IOPP), 2019
Keywords
cerebral arteries, hemodynamics, carotid stenosis, magnetic resonance imaging, circle of willis, cerebrovascular circulation
National Category
Medical Image Processing
Identifiers
urn:nbn:se:umu:diva-147254 (URN)10.1088/2057-1976/aae8d1 (DOI)000457627700003 ()
Funder
Swedish Research Council, 2015-05616Swedish Heart Lung Foundation, 20110383, 20140592
Note

Originally included in thesis in manuscript form

Available from: 2018-04-30 Created: 2018-04-30 Last updated: 2019-11-19Bibliographically approved
Dunås, T., Holmgren, M., Wåhlin, A., Malm, J. & Eklund, A. (2019). Accuracy of blood flow assessment in cerebral arteries with 4D flow MRI: Evaluation with three segmentation methods. Journal of Magnetic Resonance Imaging, 50(2), 511-518
Open this publication in new window or tab >>Accuracy of blood flow assessment in cerebral arteries with 4D flow MRI: Evaluation with three segmentation methods
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2019 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 50, no 2, p. 511-518Article in journal (Refereed) Published
Abstract [en]

Background: Accelerated 4D flow MRI allows for high‐resolution velocity measurements with whole‐brain coverage. Such scans are increasingly used to calculate flow rates of individual arteries in the vascular tree, but detailed information about the accuracy and precision in relation to different postprocessing options is lacking.

Purpose: To evaluate and optimize three proposed segmentation methods and determine the accuracy of in vivo 4D flow MRI blood flow rate assessments in major cerebral arteries, with high‐resolution 2D PCMRI as a reference.

Study Type: Prospective.

Subjects: Thirty‐five subjects (20 women, 79 ± 5 years, range 70–91 years).

Field Strength/Sequence: 4D flow MRI with PC‐VIPR and 2D PCMRI acquired with a 3 T scanner.

Assessment: We compared blood flow rates measured with 4D flow MRI, to the reference, in nine main cerebral arteries. Lumen segmentation in the 4D flow MRI was performed with k‐means clustering using four different input datasets, and with two types of thresholding methods. The threshold was defined as a percentage of the maximum intensity value in the complex difference image. Local and global thresholding approaches were used, with evaluated thresholds from 6–26%.

Statistical Tests: Paired t‐test, F‐test, linear correlation (P < 0.05 was considered significant) along with intraclass correlation (ICC).

Results: With the thresholding methods, the lowest average flow difference was obtained for 20% local (0.02 ± 15.0 ml/min, ICC = 0.97, n = 310) or 10% global (0.08 ± 17.3 ml/min, ICC = 0.97, n = 310) thresholding with a significant lower standard deviation for local (F‐test, P = 0.01). For all clustering methods, we found a large systematic underestimation of flow compared with 2D PCMRI (16.1–22.3 ml/min).

Data Conclusion: A locally adapted threshold value gives a more stable result compared with a globally fixed threshold. 4D flow with the proposed segmentation method has the potential to become a useful reliable clinical tool for assessment of blood flow in the major cerebral arteries.

Level of Evidence: 2

Technical Efficacy: Stage 2

Keywords
magnetic resonance imaging, cerebral arteries, phase‐contrast MRI, 4D flow MRI, cerebral blood flow, Circle of Willis
National Category
Medical Image Processing
Identifiers
urn:nbn:se:umu:diva-147255 (URN)10.1002/jmri.26641 (DOI)000475681600017 ()30637846 (PubMedID)2-s2.0-85059966858 (Scopus ID)
Funder
Swedish Research Council, 2015–05616; 2017-04949Swedish Heart Lung Foundation, 20140592
Note

Originally included in thesis in manuscript form with title "Blood flow assessment in cerebral arteries with 4D flow MRI, concordance with 2D PCMRI"

Available from: 2018-04-30 Created: 2018-04-30 Last updated: 2019-11-19Bibliographically approved
Holmgren, M., Wåhlin, A., Dunås, T., Malm, J. & Eklund, A. (2019). Assessment of Cerebral Blood Flow Pulsatility and Cerebral Arterial Compliance With 4D Flow MRI. Journal of Magnetic Resonance Imaging
Open this publication in new window or tab >>Assessment of Cerebral Blood Flow Pulsatility and Cerebral Arterial Compliance With 4D Flow MRI
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2019 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Four-dimensional flow magnetic resonance imaging (4D flow MRI) enables efficient investigation of cerebral blood flow pulsatility in the cerebral arteries. This is important for exploring hemodynamic mechanisms behind vascular diseases associated with arterial pulsations.

PURPOSE: To investigate the feasibility of pulsatility assessments with 4D flow MRI, its agreement with reference two-dimensional phase-contrast MRI (2D PC-MRI) measurements, and to demonstrate how 4D flow MRI can be used to assess cerebral arterial compliance and cerebrovascular resistance in major cerebral arteries.

STUDY TYPE: Prospective.

SUBJECTS: Thirty-five subjects (20 women, 79 ± 5 years, range 70-91 years).

FIELD STRENGTH/SEQUENCE: 4D flow MRI (PC-VIPR) and 2D PC-MRI acquired with a 3T scanner.

ASSESSMENT: Time-resolved flow was assessed in nine cerebral arteries. From the pulsatile flow waveform in each artery, amplitude (ΔQ), volume load (ΔV), and pulsatility index (PI) were calculated. To reduce high-frequency noise in the 4D flow MRI data, the flow waveforms were low-pass filtered. From the total cerebral blood flow, total PI (PItot ), total volume load (ΔVtot ), cerebral arterial compliance (C), and cerebrovascular resistance (R) were calculated.

STATISTICAL TESTS: Two-tailed paired t-test, intraclass correlation (ICC).

RESULTS: There was no difference in ΔQ between 4D flow MRI and the reference (0.00 ± 0.022 ml/s, mean ± SEM, P = 0.97, ICC = 0.95, n = 310) with a cutoff frequency of 1.9 Hz and 15 cut plane long arterial segments. For ΔV, the difference was -0.006 ± 0.003 ml (mean ± SEM, P = 0.07, ICC = 0.93, n = 310) without filtering. Total R was 11.4 ± 2.41 mmHg/(ml/s) (mean ± SD) and C was 0.021 ± 0.009 ml/mmHg (mean ± SD). ΔVtot was 1.21 ± 0.29 ml (mean ± SD) with an ICC of 0.82 compared with the reference. PItot was 1.08 ± 0.21 (mean ± SD).

DATA CONCLUSION: We successfully assessed 4D flow MRI cerebral arterial pulsatility, cerebral arterial compliance, and cerebrovascular resistance. Averaging of multiple cut planes and low-pass filtering was necessary to assess accurate peak-to-peak features in the flow rate waveforms.

LEVEL OF EVIDENCE: 2

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
2D PC-MRI, 4D flow MRI, cerebral arterial compliance, cerebrovascular resistance, circle of Willis, pulsatility index
National Category
Medical Engineering
Identifiers
urn:nbn:se:umu:diva-165203 (URN)10.1002/jmri.26978 (DOI)000495792500001 ()31713964 (PubMedID)
Funder
Swedish Research Council, 2015–05616Swedish Heart Lung Foundation, 20140592Swedish Research Council, 2017-04949
Available from: 2019-11-20 Created: 2019-11-20 Last updated: 2019-12-10
Zarrinkoob, L., Wåhlin, A., Ambarki, K., Birgander, R., Eklund, A. & Malm, J. (2019). Blood flow lateralization and collateral compensatory mechanisms in patients with carotid artery stenosis. Stroke, 50(5), 1081-1088
Open this publication in new window or tab >>Blood flow lateralization and collateral compensatory mechanisms in patients with carotid artery stenosis
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2019 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 50, no 5, p. 1081-1088Article in journal (Refereed) Published
Abstract [en]

Background and Purpose: Four-dimensional phase-contrast magnetic resonance imaging enables quantification of blood flow rate (BFR; mL/min) in multiple cerebral arteries simultaneously, making it a promising technique for hemodynamic investigation in patients with stroke. The aim of this study was to quantify the hemodynamic disturbance and the compensatory pattern of collateral flow in patients with symptomatic carotid stenosis.

Methods: Thirty-eight patients (mean, 72 years; 27 men) with symptomatic carotid stenosis (>/=50%) or occlusion were investigated using 4-dimensional phase-contrast magnetic resonance imaging. For each patient, BFR was measured in 19 arteries/locations. The ipsilateral side to the symptomatic carotid stenosis was compared with the contralateral side.

Results: Internal carotid artery BFR was lower on the ipsilateral side (134+/-87 versus 261+/-95 mL/min; P<0.001). BFR in anterior cerebral artery (A1 segment) was lower on ipsilateral side (35+/-58 versus 119+/-72 mL/min; P<0.001). Anterior cerebral artery territory bilaterally was primarily supplied by contralateral internal carotid artery. The ipsilateral internal carotid artery mainly supplied the ipsilateral middle cerebral artery (MCA) territory. MCA was also supplied by a reversed BFR found in the ophthalmic and the posterior communicating artery routes on the ipsilateral side (-5+/-28 versus 10+/-28 mL/min, P=0.001, and -2+/-12 versus 6+/-6 mL/min, P=0.03, respectively). Despite these compensations, BFR in MCA was lower on the ipsilateral side, and this laterality was more pronounced in patients with severe carotid stenosis (>/=70%). Although comparing ipsilateral MCA BFR between stenosis groups (<70% and >/=70%), there was no difference ( P=0.95).

Conclusions: With a novel approach using 4-dimensional phase-contrast magnetic resonance imaging, we could simultaneously quantify and rank the importance of collateral routes in patients with carotid stenosis. An important observation was that contralateral internal carotid artery mainly secured the bilateral anterior cerebral artery territory. Because of the collateral recruitment, compromised BFR in MCA is not necessarily related to the degree of carotid stenosis. These findings highlight the importance of simultaneous investigation of the hemodynamics of the entire cerebral arterial tree.

Place, publisher, year, edition, pages
Philadelphia: Lippincott Williams & Wilkins, 2019
Keywords
carotid stenosis, circle of Willis, humans, magnetic resonance imaging, cine, middle cerebral artery
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-158003 (URN)10.1161/STROKEAHA.119.024757 (DOI)000469350000029 ()30943887 (PubMedID)
Funder
Swedish Research Council, 2015-05616Swedish Research Council, 2017-04949Västerbotten County CouncilSwedish Heart Lung Foundation, 20140592
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-11-19Bibliographically approved
Holmlund, P., Qvarlander, S., Malm, J. & Eklund, A. (2019). Can pulsatile CSF flow across the cerebral aqueduct cause ventriculomegaly?: A prospective study of patients with communicating hydrocephalus.. Fluids and Barriers of the CNS, 16(1), Article ID 40.
Open this publication in new window or tab >>Can pulsatile CSF flow across the cerebral aqueduct cause ventriculomegaly?: A prospective study of patients with communicating hydrocephalus.
2019 (English)In: Fluids and Barriers of the CNS, ISSN 2045-8118, E-ISSN 2045-8118, Vol. 16, no 1, article id 40Article in journal (Refereed) Published
Abstract [en]

Background: Communicating hydrocephalus is a disease where the cerebral ventricles are enlarged. It is characterized by the absence of detectable cerebrospinal fluid (CSF) outflow obstructions and often with increased CSF pulsatility measured in the cerebral aqueduct (CA). We hypothesize that the cardiac-related pulsatile flow over the CA, with fast systolic outflow and slow diastolic inflow, can generate net pressure effects that could source the ventriculomegaly in these patients. This would require a non-zero cardiac cycle averaged net pressure difference (ΔPnet) over the CA, with higher average pressure in the lateral and third ventricles.

Methods: We tested the hypothesis by calculating ΔPnet across the CA using computational fluid dynamics based on prospectively collected high-resolution structural (FIESTA-C, resolution 0.39 × 0.39 × 0.3 mm3) and velocimetric (2D-PCMRI, in-plane resolution 0.35 × 0.35 mm2) MRI-data from 30 patients investigated for communicating hydrocephalus.

Results: The ΔPnet due to CSF pulsations was non-zero for the study group (p = 0.03) with a magnitude of 0.2 ± 0.4 Pa (0.001 ± 0.003 mmHg), with higher pressure in the third ventricle. The maximum pressure difference over the cardiac cycle ΔPmax was 20.3 ± 11.8 Pa and occurred during systole. A generalized linear model verified an association between ΔPnet and CA cross-sectional area (p = 0.01) and flow asymmetry, described by the ratio of maximum inflow/outflow (p = 0.04), but not for aqueductal stroke volume (p = 0.35).

Conclusions: The results supported the hypothesis with respect to the direction of ΔPnet, although the magnitude was low. Thus, although the pulsations may generate a pressure difference across the CA it is likely too small to explain the ventriculomegaly in communicating hydrocephalus.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Communicating hydrocephalus, computational fluid dynamics, cerebrospinal fluid pressure, brain imaging, cerebral aqueduct
National Category
Medical Engineering
Identifiers
urn:nbn:se:umu:diva-157029 (URN)10.1186/s12987-019-0159-0 (DOI)000504082400001 ()31865917 (PubMedID)
Funder
Swedish National Space BoardSwedish Research Council, grant 2015-05616Swedish Heart Lung Foundation, grant 20140592
Note

Originally included in thesis in manuscript form

Available from: 2019-03-06 Created: 2019-03-06 Last updated: 2020-01-09Bibliographically approved
Birnefeld, J., Wåhlin, A., Eklund, A. & Malm, J. (2019). Cerebral arterial pulsatility is associated with features of small vessel disease in patients with acute stroke and TIA: a 4D flow MRI study. Journal of Neurology
Open this publication in new window or tab >>Cerebral arterial pulsatility is associated with features of small vessel disease in patients with acute stroke and TIA: a 4D flow MRI study
2019 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459Article in journal (Refereed) Epub ahead of print
Abstract [en]

Cerebral small vessel disease (SVD) is a major cause of stroke and cognitive impairment. However, the underlying mechanisms behind SVD are still poorly understood. High cerebral arterial pulsatility has been suggested as a possible cause of SVD. In population studies, arterial pulsatility has been linked to white matter hyperintensities (WMH), cerebral atrophy, and cognitive impairment, all features of SVD. In stroke, pulsatility data are scarce and contradictory. The aim of this study was to investigate the relationship between arterial pulsatility and SVD in stroke patients. With a cross-sectional design, 89 patients with acute ischemic stroke or TIA were examined with MRI. A neuropsychological assessment was performed 1 year later. Using 4D flow MRI, pulsatile indices (PI) were calculated for the internal carotid artery (ICA) and middle cerebral artery (M1, M3). Flow volume pulsatility (FVP), a measure corresponding to the cyclic expansion of the arterial tree, was calculated for the same locations. These parameters were assessed for associations with WMH volume, brain volume and cognitive function. ICA-FVP was associated with WMH volume (β = 1.67, 95% CI: [0.1, 3.24], p = 0.037). M1-PI and M1-FVP were associated with decreasing cognitive function (β = - 4.4, 95% CI: [- 7.7, - 1.1], p = 0.009 and β = - 13.15, 95% CI: [- 24.26, - 2.04], p = 0.02 respectively). In summary, this supports an association between arterial pulsatility and SVD in stroke patients, and provides a potential target for further research and preventative treatment. FVP may become a useful biomarker for assessing pulsatile stress with PCMRI and 4D flow MRI.

Keywords
4D flow MRI, Pulsatile index, Pulsatility, Small vessel disease, White matter hyperintensities
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:umu:diva-167287 (URN)10.1007/s00415-019-09620-6 (DOI)31728712 (PubMedID)
Funder
Swedish Research Council, 2015-05616Swedish Research Council, 2017-04949Swedish Heart Lung Foundation, 20110383Swedish Heart Lung Foundation, 20140592The Swedish Brain Foundation
Available from: 2020-01-15 Created: 2020-01-15 Last updated: 2020-01-17Bibliographically approved
Israelsson Larsen, H., Eklund, A. & Malm, J. (2019). Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery, Article ID nyz297.
Open this publication in new window or tab >>Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus
2019 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, article id nyz297Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The short- and long-term impact of cerebrospinal fluid shunting on quality of life (QoL) in idiopathic normal pressure hydrocephalus (INPH) is poorly understood.

OBJECTIVE: To investigate QoL in shunted INPH patients compared to the population and to investigate which factors influence QoL in INPH.

METHODS: INPH patients consecutively shunted in Sweden during 2008-2010 were scrutinized. Population-based controls were age- and sex-matched to the patients. Included participants were the following: 176 INPH patients and 368 controls. QoL was assessed using the EuroQol 5-dimension 5-level (EQ5D5L) instrument, which measures overall QoL and health status in 5 dimensions. Independency (accommodation and/or need for in-home care) and comorbidities were assessed. Patients were followed up 6-45 mo after surgery (mean follow-up time: 21 mo).

RESULTS: Shunting improved QoL (P < .001) and health status in all dimensions (P < .005). Shunted INPH patients had lower QoL than controls (P < .001). The patients' health status in mobility, self-care, daily activities, and anxiety/depression was worse than the controls both before and after surgery (P < .001). The main predictors of low QoL in INPH were symptoms of depression (P < .001) and severity of gait disturbance (P = .001). Fewer INPH patients than controls lived independently (45% vs 85%, P < .001). Time after shunting had no influence on QoL.

CONCLUSION: QoL remains improved in shunted INPH patients at a mean follow-up time of 21 mo, but the patients do not reach the same QoL as the population. Symptoms of depression and severity of gait disturbance are the strongest predictors of low QoL in INPH.

Keywords
Case-control studies, Dementia, Depression, Follow-up studies, Hydrocephalus, INPH CRASH, Normal pressure, Quality of life
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:umu:diva-167309 (URN)10.1093/neuros/nyz297 (DOI)31504827 (PubMedID)
Available from: 2020-01-15 Created: 2020-01-15 Last updated: 2020-01-17
Vikner, T., Nyberg, L., Holmgren, M., Malm, J., Eklund, A. & Wåhlin, A. (2019). Characterizing pulsatility in distal cerebral arteries using 4D flow MRI. Journal of Cerebral Blood Flow and Metabolism
Open this publication in new window or tab >>Characterizing pulsatility in distal cerebral arteries using 4D flow MRI
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2019 (English)In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016Article in journal (Refereed) Epub ahead of print
Abstract [en]

Recent reports have suggested that age-related arterial stiffening and excessive cerebral arterial pulsatility cause blood-brain barrier breakdown, brain atrophy and cognitive decline. This has spurred interest in developing non-invasive methods to measure pulsatility in distal vessels, closer to the cerebral microcirculation. Here, we report a method based on four-dimensional (4D) flow MRI to estimate a global composite flow waveform of distal cerebral arteries. The method is based on finding and sampling arterial waveforms from thousands of cross sections in numerous small vessels of the brain, originating from cerebral cortical arteries. We demonstrate agreement with internal and external reference methods and show the ability to capture significant increases in distal cerebral arterial pulsatility as a function of age. The proposed approach can be used to advance our understanding regarding excessive arterial pulsatility as a potential trigger of cognitive decline and dementia.

Keywords
4D flow MRI, cerebral hemodynamics, arterial pulsatility, cerebral cortical arteries, aging
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-166582 (URN)10.1177/0271678X19886667 (DOI)000497309400001 ()31722598 (PubMedID)
Funder
Swedish Research Council, 2015-05616Swedish Research Council, 2017-04949
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2019-12-20
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