Isolated Lateral Collateral Ligament Injury of the Knee in a Judo Athlete: A Surgical Case Report.

Introduction: We report a rare case of surgical treatment for an isolated lateral collateral ligament (LCL) injury of the knee that was difficult to correctly diagnose considering physical findings alone of a judo athlete. Case Report: The 27-year-old man complained of pain on the lateral side of the right knee and discomfort and balance instability when climbing and descending stairs. During a judo match, he stepped on his right foot to prevent his opponent's waza (techniques), causing forced varus on his knee in a slight flexion position. His right knee showed no apparent sway in the manual test, but pain around the fibular head was induced in the figure-of-four position, and the LCL could not be palpated. Joint instability was not detected on varus stress roentgenography, but magnetic resonance imaging showed signal changes and an abnormal course in the fibula head insertion at the distal part of the LCL. Although no instability was observed objectively, clinical findings diagnosed LCL as an isolated injury, and surgical treatment was performed. Six months after the operation, his symptoms improved, and he resumed competing in judo. Conclusion: To correctly diagnose an isolated LCL injury of the knee, it is important to consider patient history and physical findings. Repair of the injury could improve subjective symptoms, such as pain, discomfort, and balance instability, even if objective instability is not observed.

Far anteromedial portal technique for posterolateral femoral tunnel drilling in anatomic double-bundle anterior cruciate ligament reconstruction: a cadaveric study.

PURPOSE: To identify the relationship between knee flexion angle and femoral tunnel length, as well as the exit points of guidewires, when using a far anteromedial portal technique for posterolateral femoral tunnel drilling in double-bundle anterior cruciate ligament reconstruction. METHODS: Using the far anteromedial portal technique in 8 cadaveric knees, femoral tunnel drilling for the posterolateral bundle was performed at 3 knee flexion angles: 90°, 110° and 130°. We measured the femoral tunnel length and the distances from each guidewire to the closest relevant structures. RESULTS: The mean tunnel length at 90° knee flexion (25.8 ± 1.8 mm) was significantly shorter than the length at 110° and 130° knee flexion (32.1 ± 2.6 and 33.1 ± 2.5 mm, respectively). The average distance between the exit point of the guidewire and the posterior articular cartilage of the lateral femoral condyle was the shortest at 90° knee flexion (3.3 ± 2.2 mm). The distance between the guidewire and the centre of the origin of the lateral collateral ligament was the shortest at 130° knee flexion (8.0 ± 1.8 mm). The guidewires penetrated the origin of the lateral gastrocnemius tendon in 2 cases at 110° knee flexion and in 1 case each at 90° and 130° knee flexion. CONCLUSIONS: When using the far anteromedial portal technique, more than 110° knee flexion is desirable to achieve ideal femoral tunnel length and avoid articular cartilage injury. In addition, the risk of damage to the origin of the lateral collateral ligament increases when the knee flexion angle increases to 130°. A knee flexion angle between 110° and 120° was recommended when using the far anteromedial portal technique.

Myocardial scintigraphy may predict the conversion to probable dementia with Lewy bodies.

OBJECTIVE: To compare the usefulness of brain perfusion SPECT and (123)I-metaiodobenzylguanidine ((123)I-MIBG) in predicting the conversion of possible dementia with Lewy bodies (DLB) to probable DLB. METHODS: We examined 94 patients with possible DLB based on the Consensus Criteria for the Clinical Diagnosis of DLB by N-Isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) brain perfusion SPECT and (123)I-MIBG myocardial scintigraphy. After 1 year of follow-up, 33 of 94 patients met the criteria for probable DLB. (123)I-IMP brain perfusion SPECT and (123)I-MIBG myocardial scintigraphy were tested as predictors of the conversion from possible DLB to probable DLB. A receiver operating characteristic (ROC) analysis was performed. RESULTS: The areas under the ROC curves for SPECT for predicting the conversion to probable DLB from possible DLB based on the occipital/cerebellum and occipital/striatum cortex ratios of blood flow counts were 0.591 and 0.585, respectively. The areas under the ROC curves for (123)I-MIBG based on the early heart to mediastinum (H/M) ratio, delayed H/M ratio, and washout rate were 0.935, 0.936, and 0.884, respectively. CONCLUSION: (123)I-MIBG myocardial scintigraphy is a good predictor of the future conversion of possible DLB to probable DLB.

Strong adhesiveness of a new biodegradable hydrogel glue, LYDEX, for use on articular cartilage.

AIM: Until recently, only fibrin glue has been available for clinical usage to repair articular cartilage, although its adhesiveness is not strong enough for use with articular cartilage, and it is derived from human blood and thus carries the risk of contamination. Recently, LYDEX, a new biodegradable hydrogel glue, has come onto the market. The purpose of this study was to evaluate the adhesive strength and cytotoxicity of LYDEX when used on articular cartilage. MATERIALS AND METHODS: The differing adhesive strengths of collagen membrane and articular cartilage with LYDEX versus with fibrin glue were measured using a tensile tester. In addition, the cytotoxicity of LYDEX in vitro was evaluated. The cytotoxicity of LYDEX for the articular cartilage of rats was evaluated histopathologically. RESULTS: The adhesive strength of LYDEX was significantly stronger than that of fibrin glue, giving values about 3.8 times higher. LYDEX has no discernible effect on normal articular cartilage. CONCLUSIONS: Our study is the first to assess the usefulness and safety of LYDEX for use on articular cartilage.

Articular cartilage repair with magnetic mesenchymal stem cells.

BACKGROUND: Cell therapies are hampered by the difficulty of delivering cells to and retaining them in target tissues long enough to repair or regenerate local tissues. HYPOTHESIS: Magnetic-assisted delivery of magnetically labeled mesenchymal stem cells (m-MSCs) would be rapid, allowing for chondrogenic differentiation and functional joint repair without replacement. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen mini-pigs aged 6 to 7 months were used. A full-thickness cartilage defect was created in the center of the patella with a cylindrical punch (diameter, 6 mm). At 4 weeks after creation of the cartilage defects, the animals were divided into 3 treatment groups: In the M group, m-MSCs (5 × 10(6) cells) were injected and accumulated to the cartilage defect using an external magnetic force (1.5 T) for 10 minutes; in the G group, the patella was faced upward, filled with MSCs (5 × 10(6) cells), and held for 10 minutes; and in the C group, only phosphate-buffered saline was injected. The regenerated cartilage was evaluated in 5 knees in each of the 3 groups by arthroscopic surgery at 6 and 12 weeks and histological and ultrasound evaluation at 12 and 24 weeks. RESULTS: The mean arthroscopic scores at 6 weeks were 10.4 ± 1.10 in the M group, 8.8 ± 0.84 in the G group, and 7.4 ± 0.89 in the C group. There was a statistically significant difference between the M group and the other 2 groups. The mean arthroscopic scores at 12 weeks were 12.8 ± 1.30 (M group), 10.5 ± 1.30 (G group), and 9.5 ± 0.58 (C group), with a statistically significant difference between the M and C groups. The mean histological scores using the Wakitani scoring system at 12 weeks were 2.8 ± 0.96 (M group), 5.4 ± 0.55 (G group), and 6.0 ± 2.20 (C group), and the mean histological scores at 24 weeks were 2.4 ± 1.50 (M group), 3.5 ± 0.56 (G group), and 5.3 ± 1.50 (C group). The mean histological scores at 12 weeks were significantly better in the M group than in the other groups, and the M group maintained a significantly better histological score than did the C group at 24 weeks. CONCLUSION: The m-MSCs had no adverse effect on chondrogenic differentiation, and m-MSCs delivered by magnetic field application repaired cartilage defects. CLINICAL RELEVANCE: The clinical application of this novel stem cell delivery system is a potential therapeutic option for treating cartilage defects and may be more applicable throughout the body than traditional methods.

Predictors of the disappearance of triad symptoms in patients with idiopathic normal pressure hydrocephalus after shunt surgery.

We identified factors that predict the disappearance of the triad of symptoms (gait disturbance, cognitive impairment and urinary incontinence) of idiopathic normal pressure hydrocephalus (iNPH) following shunt surgery in this study. We classified 71 patients with iNPH into those whose objective symptoms disappeared (disappearance group) or remained (residual group), for each of the triad symptoms 12 months after shunt surgery. Logistic regression analyses were used to identify the predictors of the disappearance of symptoms among 10 variables before shunt surgery (e.g., age, sex, severity of symptoms, Evans index, cerebrospinal fluid (CSF) pressure, CSF stasis on computerized tomographic cisternography, regional cerebral blood flow on single photon emission computed tomography, three kinds of prior diseases). For each of the triad symptoms, mild symptoms before shunt surgery were predictors of the disappearance of the symptom. Young age was also a predictor of the disappearance of gait disturbance. When the analysis was conducted using subscores of the Mini Mental State Examination, a successful visuoconstruction subtest and an absence of hypertension were predictors of the disappearance of cognitive impairment. None of the neuroimaging examinations predicted the disappearance of symptoms after shunt surgery in this study.

A new distraction arthroplasty device using magnetic force; a cadaveric study.

BACKGROUND: It is difficult for an articular cartilage injury to repair spontaneously. There are many procedures for treating cartilage injury, however there is no standard procedure for middle-aged patients who have diffuse knee osteoarthritis, especially of the lateral compartment. Therefore, Ochi developed a new distraction device that uses magnetic power to enlarge a joint space and promote cartilage regeneration with microfracture. The purpose of this study is to evaluate this new distraction arthroplasty system by using the cadaveric knee. METHODS: This study used ten knees from six cadavers that were embalmed by Thiel's methods. The medial and lateral joint space was measured by AP radiographic view before and after distraction, and after weight-bearing to evaluate the joint distraction. The contact pressure of the medial and lateral compartments at the knee extension position by using a prescale film system was measured before and after weight-bearing with a 15 or 30-kg weight-bearing load to evaluate the effectiveness of this device. FINDINGS: The lateral joint space significantly increased from the pre-distraction to the post-distraction; however, it did not change significantly between post-distraction and post-weight-bearing. With a 15 or 30-kg weight-bearing load, the contact pressure of the lateral compartment significantly decreased from the pre-distraction to the post-distraction. INTERPRETATION: The most important advantage of this device is that it maintains a continuous distraction tension and enables almost the full range of motion of the knee. We believe that joint distraction by using magnetic force can be a promising option for cartilage injury in middle-aged patients.

Magnetic targeting of human peripheral blood CD133+ cells for skeletal muscle regeneration.

Skeletal muscle injuries often leave lasting functional damage or pain. Muscle injuries are routinely treated conservatively, but the most effective treatment to promote the repair of injured muscles has not yet been established. Our previous report demonstrated that human peripheral blood-derived CD133(+) cell transplantation to rat skeletal muscle injury models inhibited fibrosis and enhanced myogenesis after injury. However, the acquisition of a sufficient number of cells remains the limitation for clinical application, as the CD133(+) population is rare in human blood. In this study, we applied a magnetic cell targeting system to accumulate transplanted cells in the muscle injury site and to enhance the regenerative effects of CD133(+) cell transplantation, focusing on the fact that CD133(+) cells are labeled with a magnetic bead for isolation. For the magnetic cell targeting, the magnet field generator was set up to adjust the peak of the magnetic gradient to the injury site of the tibialis anterior muscle, and 1×10(4) human peripheral blood CD133(+) cells were locally injected into the injury site. This cell number is 10% of that used in the previous study. In another group, the same number of CD133(+) cells was injected without magnetic force. The CD133(+) cells transplanted with the magnetic force were more accumulated in the muscle injury site compared with the CD133(+) cells transplanted without the magnetic force. In addition, the transplantation of CD133(+) cells under the magnetic control inhibited fibrous scar formation and promoted angiogenesis and myogenesis, and also upregulated the mRNA expression of myogenic transcription factors, including Pax7, MyoD1 and Myogenin. However, the transplantation of CD133(+) cells without the magnetic force failed to demonstrate these effects. Thus, our magnetic cell targeting system enables transplantation of a limited number of CD133(+) cells to promote the repair of skeletal muscle injury.

In vivo bioluminescence imaging of magnetically targeted bone marrow-derived mesenchymal stem cells in skeletal muscle injury model.

The purpose of this study is to clarify the kinetics of transplanted mesenchymal stem cells (MSCs) in rat skeletal muscle injury model and the contribution of the magnetic cell delivery system to muscle injury repair. A magnetic field generator was used to apply an external magnetic force to the injury site of the tibia anterior muscle, and 1 × 10(6) MSCs labeled with ferucarbotran-protamine complexes, which were isolated from luciferase transgenic rats, were injected into the injury site. MSCs were injected with and without an external magnetic force (MSC M+ and MSC M- groups, respectively), and phosphate-buffered saline was injected into injury sites as a control. In vivo bioluminescence imaging was performed immediately after the transplantation and, at 12, 24, and 72 h, and 1 and 4 weeks post-transplantation. Also, muscle regeneration and function were histologically and electromechanically evaluated. In vivo bioluminescence imaging showed that the photon of the MSC M+ group was significantly higher than that of the MSC M- group throughout the observation period. In addition, muscle regeneration and function in the MSC M+ group was histologically and functionally better than that of the MSC M- group. The results of our study indicated that magnetic cell delivery system may be of use in directing the transplanted MSCs to the injury site to promote skeletal muscle regeneration.

The relationship of anterior and rotatory laxity between surgical navigation and clinical outcome after ACL reconstruction.

PURPOSE: Recently, a computer-assisted navigation system has been used for the quantitative evaluation not only of anterior-posterior (AP) laxity but also rotational laxity of the tibia intraoperatively. The purpose of this study was to investigate how intraoperative AP or rotational laxities measured by the navigation system could correlate with postoperative AP and rotational laxities of the patients. METHODS: 125 patients who underwent primary isolated anatomical single- or double-bundle ACL reconstruction or augmentation using multistranded autologous hamstring tendons were included in the study after a minimum of 2-year follow-up. Clinically, absolute value and side-to-side difference (SSD) of AP translation of the tibia were measured by KT-2000 preoperatively and postoperatively. Intraoperative measurement of AP translation of the tibia and total range of tibial rotation of the ACL-injured knee were carried out using the computer-assisted navigation system. We have investigated the relationship between intraoperative measurements using the navigation system and AP laxity measurements using the KT-2000 knee arthrometer as well as rotational laxity measurements using the manual pivot shift test. RESULTS: There was a positive correlation between the SSD of preoperative AP translation of the tibia measured by KT-2000 arthrometer and the reduction in AP laxity following ACL reconstruction measured by the navigation system. However, we found no significant correlation between the reduction in AP laxity measured by the navigation system and the SSD of AP translation of the tibia measured by the KT-2000 arthrometer at final follow-up. Postoperatively, eight patients had a positive pivot shift test. Using the navigation system pre- and post-ACL reconstruction, these patients could not be identified by high absolute values for AP laxity nor rotational laxity. CONCLUSION: Although AP and rotational laxities vary largely among the patients, and AP and rotational stabilization are successfully achieved immediately after ACL reconstruction, intraoperative AP and rotational laxity measured by the navigation system did not influence the postoperative AP and rotational laxities after ACL reconstruction. LEVEL OF EVIDENCE: III.

Characteristic shape of the lateral femoral condyle in patients with osteochondritis dissecans accompanied by a discoid lateral meniscus.

BACKGROUND: There are various indirect signs of a discoid lateral meniscus in radiographs, for example lateral joint space widening, hypoplasia of the LFC, etc. There has, however, been no previous report of the characteristic shape of the lateral femoral condyle (LFC) in patients with osteochondritis dissecans (OCD) accompanied by a discoid lateral meniscus. The purpose of this study was to evaluate the characteristic shape of the LFC in patients with OCD accompanied by a discoid lateral meniscus, and sex differences associated with the shape of the LFC in those patients. METHODS: This study included 29 males (31 knees) and 29 females (32 knees) of average age 17.7 years. There were 15 knees in 15 patients that were accompanied by OCD of the LFC (9 males, 9 knees; 6 females, 6 knees; average age 14.9 years; OCD group). There were 48 knees in 43 patients that were not accompanied by OCD of the LFC (20 males, 22 knees; 23 females, 26 knees; average age 17.6 years; non-OCD group). Standardized Rosenberg view radiographs of the knee were obtained for all patients. We evaluated the shape of LFC using the Rosenberg view and measured the condylar prominence ratio of the medial and lateral condyles adjacent to the intercondylar notch, in accordance with Ha's procedure. RESULTS: The OCD group had a significantly larger prominence ratio than the non-OCD group. The prominence ratio for males was significantly larger than that for females. CONCLUSION: We clearly demonstrated that the prominence ratio in the OCD group was significantly larger than that in the non-OCD group, indicating that the shape of the LFC and OCD in the LFC may be associated with the development of these lesions.

The transverse ligament as a landmark for tibial sagittal insertions of the anterior cruciate ligament: a cadaveric study.

PURPOSE: The purpose of this study was to determine the relation between the position of the transverse ligament, the anterior edge of the anterior cruciate ligament (ACL) tibial footprint, and the center of the ACL tibial insertion. We used arthroscopy for localization of the anatomic landmarks, followed by insertions of guide pins under direct visualization, and then the position of these guide pins was checked on plain lateral radiographs. METHODS: The transverse ligament and the anterior aspect of the ACL tibial footprint were identified by arthroscopy in 20 unpaired cadaveric knees (10 left and 10 right). Guide pins were inserted with tibial ACL adapter drill guides under direct observation at the transverse ligament, the anterior aspect of the tibial footprint, and the center of tibial insertion of the ACL. Then, plain lateral radiographs of specimens were taken. The Amis and Jakob line was used to define the attachment of the ACL tibial insertion and the transverse ligament. A sagittal percentage of the location of the insertion point was determined and calculated from the anterior margin of the tibia in the anteroposterior direction. RESULTS: The transverse ligament averaged 21.20% ± 4.1%, the anterior edge of the ACL tibial insertion averaged 21.60% ± 4.0%, and the center of the ACL tibial insertion averaged 40.30% ± 4.8%. There were similar percent variations between the transverse ligament and the anterior edge of the ACL tibial insertion, with no significant difference between them (P = .38). Intraobserver and interobserver reliability was high, with small standard errors of measurement. CONCLUSIONS: This study shows that the transverse ligament coincides with the anterior edge of the ACL tibial footprint in the sagittal plane. CLINICAL RELEVANCE: The transverse ligament can be considered as a new landmark for tibial tunnel positioning during anatomic ACL reconstruction.

Hypoperfusion of the motor cortex associated with parkinsonism in dementia with Lewy bodies.

OBJECTIVE: This study aimed to investigate the impact of parkinsonism on regional cerebral blood flow (rCBF) in dementia with Lewy bodies (DLB). METHOD: Forty-four probable DLB patients, comprising 13 patients without parkinsonism and 31 patients with parkinsonism, and 16 normal controls were selected for this study. We evaluated the rCBF in each group by means of N-isopropyl-p-[(123)I] iodoamphetamine (IMP) and single photon emission computed tomography (SPECT). The rCBF in the different groups was compared using voxel-by-voxel Statistical Parametrical Mapping (SPM). RESULT: Patients with DLB showed low rCBF in the frontal, temporal, and occipital cortex with relative sparing of the paracentral region. DLB patients with parkinsonism (DLB-P) had lower rCBF in the primary motor cortex (M1) and left supplementary motor area (SMA) than DLB patients without parkinsonism (DLB-nonP). DLB-nonP patients showed decreased rCBF in the left temporo-occipital region. CONCLUSION: This study suggests that two distinct clinical entities are involved in DLB. In addition, CBF changes in the M1 and SMA are seen in the early stages of Parkinson's disease. This result would help in diagnosing DLB in the context of Lewy body (LB) disease.

Neuropsychiatric symptoms in patients with idiopathic normal pressure hydrocephalus.

OBJECTIVE: To clarify the characteristics of neuropsychiatric symptoms in patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS: Neuropsychiatric symptoms of 64 iNPH patients with mild triad symptoms from three kinds of hospitals were evaluated with the Neuropsychiatric Inventory (NPI) and compared with 126 patients with Alzheimer's disease (AD). RESULTS: The most frequently observed neuropsychiatric symptom in the iNPH patients was apathy followed by anxiety and aggression. No symptom was more prevalent or more severe in iNPH than in AD. The severity of cognitive impairment was correlated with both aberrant motor activity and apathy. CONCLUSIONS: Neuropsychiatric symptoms were mild in patients with iNPH and apathy was the most prevalent symptom. The correlation between neuropsychiatric symptoms and cognitive impairment in iNPH appears to arise from a common pathology in the frontal lobe.

Computer-assisted diagnostic system for neurodegenerative dementia using brain SPECT and 3D-SSP.

PURPOSE: To develop a computer-assisted automated diagnostic system to distinguish among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and other degenerative disorders in patients with mild dementia. METHODS: Single photon emission computed tomography (SPECT) images with injection of N-Isopropyl-p-[(123)I]iodoamphetamine (IMP) were obtained from patients with mild degenerative dementia. First, datasets from 20 patients mild AD, 15 patients with dementia with DLB, and 17 healthy controls were used to develop an automated diagnosing system based on three-dimensional stereotactic surface projections (3D-SSP). AD- and DLB-specific regional templates were created using 3D-SSP, and critical Z scores in the templates were established. Datasets from 50 AD patients, 8 DLB patients, and 10 patients with non-AD/DLB type degenerative dementia (5 with frontotemporal dementia and 5 with progressive supranuclear palsy) were then used to test the diagnostic accuracy of the optimized automated system in comparison to the diagnostic interpretation of conventional IMP-SPECT images. These comparisons were performed to differentiate AD and DLB from non-AD/DLB and to distinguish AD from DLB. A receiver operating characteristic (ROC) analysis was performed. RESULTS: The area under the ROC curve (Az) and the accuracy of the automated diagnosis system were 0.89 and 82%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 65%, respectively, for AD vs. DLB patients. The mean Az and the accuracy of the visual inspection were 0.84 and 77%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 65%, respectively, for AD vs. DLB patients. The mean Az and the accuracy of the combination of visual inspection and this system were 0.96 and 91%, respectively, for AD/DLB vs. non-AD/DLB patients, and 0.70 and 66%, respectively, for AD vs. DLB patients. CONCLUSION: The system developed in the present study achieved as good discrimination of AD, DLB, and other degenerative disorders in patients with mild dementia as the commonly performed visual inspection of conventional SPECT images. A combination of visual inspection and this system is helpful in the differential diagnosis of patients with mild dementia.

Global cerebral hypoperfusion in a patient with transient global amnesia.

We report a 64-year-old male patient with pure transient global amnesia (TGA) who exhibited global cerebral hypoperfusion during an amnesia attack. Initial single photon emission computed tomography (SPECT) performed 3 hours after the onset of the amnesic attack revealed diffuse hypoperfusion in the cerebrum, whereas a second SPECT study, 1 month later, revealed improvement of cerebral blood flow. This case suggests that SPECT study is useful in revealing the pathophysiological mechanism of TGA and that TGA attacks are associated with global cerebral blood flow change.

Hemispatial visual defect in Alzheimer's disease.

We describe a 56-year-old woman with Alzheimer's disease with left hemispatial neglect and left homonymous hemianopsia with macular sparing considered a manifestation of Alzheimer's disease resulting from severe degenerative change in the right primary visual cortex. Hemispatial neglect normally results from brain damage to the right cerebral hemisphere. Homonymous hemianopsia is commonly the result of localized brain disease, especially cerebral infarction or hemorrhage. To our knowledge, a patient with Alzheimer's disease showing hemispatial neglect and homonymous hemianopsia with macular sparing has not previously been reported.

Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus.

The utility of measuring the corpus callosal angle (CA) for the diagnosis of idiopathic normal pressure hydrocephalus (INPH) was investigated. Three-dimensional magnetic resonance imaging (MRI) was performed in 34 INPH patients, 34 Alzheimer's disease (AD) patients, and 34 normal control (NC) subjects. Measurement of the CA on the coronal MR images of the posterior commissure perpendicular to the anteroposterior commissure plane was performed for all subjects. The CA of the INPH group (mean +/- SD, 66 +/- 14 degrees) was significantly smaller than those of the AD (104 +/- 15 degrees) and NC (112 +/- 11 degrees) groups. When using the threshold of the mean - 2SD value of the NC group (= 90 degrees), an accuracy of 93%, sensitivity of 97%, and specificity of 88% were observed for discrimination of INPH from AD patients. Measuring the CA helps in differentiating INPH patients from AD and normally aged subjects.

Voxel-based analysis of gray matter and CSF space in idiopathic normal pressure hydrocephalus.

AIMS: To investigate regional morphologic changes in idiopathic normal pressure hydrocephalus (INPH) based on diagnosis with INPH Guidelines using voxel-based morphometry. METHOD: Three-dimensional magnetic resonance imaging was performed in 34 INPH patients, who met probable INPH criteria, probable 34 Alzheimer disease patients, and 34 normal control subjects. RESULTS: Statistical parametric mapping was used to conduct voxel-based morphometry analysis of the morphologic data and revealed enlarged ventricles and sylvian fissures and stenotic sulci of high convexity, especially in the precuneus in the INPH group, with decreased gray matter density in the insula, caudate and thalamus. CONCLUSION: In INPH, morphologic change occurs in the frontoparietal high convexity with ventricular dilatations, dilated sylvian fissures and tight sulci in the medial parietal lobes.