特発性正常圧水頭症とアルツハイマー型認知症の定量的画像指標の比較
目的：本邦の特発性正常圧水頭症（以下iNPH）診療ガイドラインでは，possible iNPHの診断基準を満たす症例に対して髄液排除試験を行うよう推奨されている．しかし頭部MRI所見が類似したアルツハイマー型認知症（以下AD）例がpossible iNPHの診断基準を満たすことも多いため，髄液排除試験の奏功率はあまり高くない．そのためADとiNPHの鑑別，およびpossible iNPHにおける髄液排除試験の有効性を予測できる簡便な定量的画像指標の探索を行った．方法：臨床的にpossible iNPHと診断され髄液排除試験を施行した18例（髄液排除試験有効12例，無効6例）と，外来通院中のpr...
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| Published in | 日本老年医学会雑誌 Vol. 49; no. 6; pp. 731 - 739 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本老年医学会
2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.49.731 |
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| Abstract | 目的：本邦の特発性正常圧水頭症（以下iNPH）診療ガイドラインでは，possible iNPHの診断基準を満たす症例に対して髄液排除試験を行うよう推奨されている．しかし頭部MRI所見が類似したアルツハイマー型認知症（以下AD）例がpossible iNPHの診断基準を満たすことも多いため，髄液排除試験の奏功率はあまり高くない．そのためADとiNPHの鑑別，およびpossible iNPHにおける髄液排除試験の有効性を予測できる簡便な定量的画像指標の探索を行った．方法：臨床的にpossible iNPHと診断され髄液排除試験を施行した18例（髄液排除試験有効12例，無効6例）と，外来通院中のprobable AD症例19例を対象とし，頭部MRI画像のVSRADのZスコア，Evans Index，側脳室前角脳幅比，鈎回間距離，内側側頭葉最小厚，海馬高，脈絡膜裂高，側脳室下角横径と縦径，シルビウス裂最大高の左右平均値を測定し，probable AD症例とpossible iNPH症例，およびpossible iNPH症例の髄液排除試験有効例と無効例で，それぞれ比較した．結果：probable AD症例に比べてpossible iNPH症例で，VSRADのZスコア，Evans Index，側脳室前角脳幅比，側脳室下角横径と縦径，シルビウス裂最大高が有意に高値であり，VSRADのZスコア，Evans Indexを除くカットオフ値はそれぞれ，0.31，6.0 mm，3.13 mm，7.6 mmであった．またpossible iNPH症例に対する髄液排除試験無効例に比べて有効例では，内側側頭葉最小厚が高値であり，そのカットオフ値は11.0 mmであった．結論：頭部MRIを用いた簡易な定量評価を行うことによりpossible iNPHとprobable ADの鑑別，possible iNPH症例に対する髄液排除試験の有効性の予測ができる可能性が示された． |
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| AbstractList | 目的：本邦の特発性正常圧水頭症（以下iNPH）診療ガイドラインでは，possible iNPHの診断基準を満たす症例に対して髄液排除試験を行うよう推奨されている．しかし頭部MRI所見が類似したアルツハイマー型認知症（以下AD）例がpossible iNPHの診断基準を満たすことも多いため，髄液排除試験の奏功率はあまり高くない．そのためADとiNPHの鑑別，およびpossible iNPHにおける髄液排除試験の有効性を予測できる簡便な定量的画像指標の探索を行った．方法：臨床的にpossible iNPHと診断され髄液排除試験を施行した18例（髄液排除試験有効12例，無効6例）と，外来通院中のprobable AD症例19例を対象とし，頭部MRI画像のVSRADのZスコア，Evans Index，側脳室前角脳幅比，鈎回間距離，内側側頭葉最小厚，海馬高，脈絡膜裂高，側脳室下角横径と縦径，シルビウス裂最大高の左右平均値を測定し，probable AD症例とpossible iNPH症例，およびpossible iNPH症例の髄液排除試験有効例と無効例で，それぞれ比較した．結果：probable AD症例に比べてpossible iNPH症例で，VSRADのZスコア，Evans Index，側脳室前角脳幅比，側脳室下角横径と縦径，シルビウス裂最大高が有意に高値であり，VSRADのZスコア，Evans Indexを除くカットオフ値はそれぞれ，0.31，6.0 mm，3.13 mm，7.6 mmであった．またpossible iNPH症例に対する髄液排除試験無効例に比べて有効例では，内側側頭葉最小厚が高値であり，そのカットオフ値は11.0 mmであった．結論：頭部MRIを用いた簡易な定量評価を行うことによりpossible iNPHとprobable ADの鑑別，possible iNPH症例に対する髄液排除試験の有効性の予測ができる可能性が示された． |
| Author | 中居, 龍平 神崎, 恒一 長谷川, 浩 小林, 義雄 輪千, 安希子 鳥羽, 研二 守屋, 佑貴子 |
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| References | 7) W-J Lee, Wang SJ, Hsu LC, Lirng JF, Wu CH, Fuh JL: Brain MRI as a predictor of CSF tap test response in patients with idiopathic normal pressure hydrocephalus. Journal of Neurology 2010; 257: 1675-1681. Epub 2010 May 29. 11) Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research 1975; z12: 189-198. 13) Yamashita F, Sasaki M, Takahashi S, Matsuda H, Kudo K, Narumi S, et al.: Detection of changes in cerebrospinal fluid space in idiopathic normal pressure hydrocephalus using voxel-based morphometry. Neuroradiology 2010; 52 (5): 381-386. Epub 2009 Oct 22. 19) Adachi M, Kawanami T, Ohshima F, Kato T: Upper midbrain profile sign and cingulate sulcus sign: MRI findings on sagittal images in idiopathic normal-pressure hydrocephalus, Alzheimer's disease, and progressive supranuclear palsy. Radiat Med 2006; 24 (8): 568-572. 12) Evans WA Jr: An encephalographic ratio for estimating the size of the cerebral venticles. Arch Neurol Psychiatry 1942; 47 (6): 931-937. 10) McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984; 34: 939-944. 1) Ishikawa M: Clinical guidelines for idiopathic normal pressure hydrocephalus. Neurologia medico-chirurgica 2004; 44: 222-223. 4) Walchenbach R, Geiger E, Thomeer RT, Vanneste JA: The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. Journal of neurology, neurosurgery, and psychiatry 2002; 72: 503-506. 8) Hashimoto M, Ishikawa M, Mori E, Kuwana N: Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal fluid research 2010; 7: 18. 2) Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J: The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome. Archives of neurology 1995; 52: 783-789. 16) Jobst KA, Smith AD, Szatmari M, Molyneux A, Esiri ME, King E, et al.: Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography. Lancet 1992; 14; 340: 1179-1183. 3) Damasceno BP, Carelli EF, Honorato DC, Facure JJ: The predictive value of cerebrospinal fluid tap-test in normal pressure hydrocephalus. Arquivos de neuro-psiquiatria 1997; 55: 179-185. 14) Giovanni B, Frisoni GB, Beltramello A, Weiss C, Geroldi C, Bianchetti A, et al.: Linear measures of atrophy in mild Alzheimer disease. AJNR. American journal of neuroradiology 1996; 17: 913-923. 5) Vassilouthis J: The syndrome of normal-pressure hydrocephalus. Journal of neurosurgery 1984; 61: 501-509. 6) Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T: CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR. American journal of neuroradiology 1998; 19: 1277-1284. 17) Holodny AI, Waxman R, George AE, Rusinek H, Kalnin AJ, de Leon M: MR differential diagnosis of normal-pressure hydrocephalus and Alzheimer disease: significance of perihippocampal fissures. AJNR Am J Neuroradiol 1998; 19: 813-819. 15) Giovanni B, Frisoni GB, Geroldi C, Beltramello A, Bianchetti A, Binetti G, et al.: Radial width of the temporal horn: a sensitive measure in Alzheimer disease. AJNR. American journal of neuroradiology 2002; 23: 35-47. 18) Hong YJ, Yoon B, Shim YS, Cho AH, Lim SC, Ahn KJ, et al.: Differences in microstructural alterations of the hippocampus in Alzheimer disease and idiopathic normal pressure hydrocephalus: a diffusion tensor imaging study. AJNR Am J Neuroradiol 2010; 1867-1872. Epub 2010 Jul 29. 9) Ishii K, Kawaguchi T, Shimada K, Ohkawa S, Miyamoto N, Kanda T, et al.: Voxel-based analysis of gray matter and CSF space in idiopathic normal pressure hydrocephalus. Dementia and geriatric cognitive disorders 2008; 25: 329-335. Epub 2008 Mar 5. 20) Yamashita F, Sasaki M, Takahashi S, Matsuda H, Kudo K, Narumi S, et al.: Detection of changes in cerebrospinal fluid space in idiopathic normal pressure hydrocephalus using voxel-based morphometry. Neuroradiology 2010; 52: 381-386. Epub 2009 Oct 22. |
| References_xml | – reference: 10) McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984; 34: 939-944. – reference: 6) Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T: CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR. American journal of neuroradiology 1998; 19: 1277-1284. – reference: 18) Hong YJ, Yoon B, Shim YS, Cho AH, Lim SC, Ahn KJ, et al.: Differences in microstructural alterations of the hippocampus in Alzheimer disease and idiopathic normal pressure hydrocephalus: a diffusion tensor imaging study. AJNR Am J Neuroradiol 2010; 1867-1872. Epub 2010 Jul 29. – reference: 17) Holodny AI, Waxman R, George AE, Rusinek H, Kalnin AJ, de Leon M: MR differential diagnosis of normal-pressure hydrocephalus and Alzheimer disease: significance of perihippocampal fissures. AJNR Am J Neuroradiol 1998; 19: 813-819. – reference: 12) Evans WA Jr: An encephalographic ratio for estimating the size of the cerebral venticles. Arch Neurol Psychiatry 1942; 47 (6): 931-937. – reference: 14) Giovanni B, Frisoni GB, Beltramello A, Weiss C, Geroldi C, Bianchetti A, et al.: Linear measures of atrophy in mild Alzheimer disease. AJNR. American journal of neuroradiology 1996; 17: 913-923. – reference: 15) Giovanni B, Frisoni GB, Geroldi C, Beltramello A, Bianchetti A, Binetti G, et al.: Radial width of the temporal horn: a sensitive measure in Alzheimer disease. AJNR. American journal of neuroradiology 2002; 23: 35-47. – reference: 11) Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research 1975; z12: 189-198. – reference: 9) Ishii K, Kawaguchi T, Shimada K, Ohkawa S, Miyamoto N, Kanda T, et al.: Voxel-based analysis of gray matter and CSF space in idiopathic normal pressure hydrocephalus. Dementia and geriatric cognitive disorders 2008; 25: 329-335. Epub 2008 Mar 5. – reference: 19) Adachi M, Kawanami T, Ohshima F, Kato T: Upper midbrain profile sign and cingulate sulcus sign: MRI findings on sagittal images in idiopathic normal-pressure hydrocephalus, Alzheimer's disease, and progressive supranuclear palsy. Radiat Med 2006; 24 (8): 568-572. – reference: 4) Walchenbach R, Geiger E, Thomeer RT, Vanneste JA: The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. Journal of neurology, neurosurgery, and psychiatry 2002; 72: 503-506. – reference: 20) Yamashita F, Sasaki M, Takahashi S, Matsuda H, Kudo K, Narumi S, et al.: Detection of changes in cerebrospinal fluid space in idiopathic normal pressure hydrocephalus using voxel-based morphometry. Neuroradiology 2010; 52: 381-386. Epub 2009 Oct 22. – reference: 3) Damasceno BP, Carelli EF, Honorato DC, Facure JJ: The predictive value of cerebrospinal fluid tap-test in normal pressure hydrocephalus. Arquivos de neuro-psiquiatria 1997; 55: 179-185. – reference: 8) Hashimoto M, Ishikawa M, Mori E, Kuwana N: Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal fluid research 2010; 7: 18. – reference: 7) W-J Lee, Wang SJ, Hsu LC, Lirng JF, Wu CH, Fuh JL: Brain MRI as a predictor of CSF tap test response in patients with idiopathic normal pressure hydrocephalus. Journal of Neurology 2010; 257: 1675-1681. Epub 2010 May 29. – reference: 1) Ishikawa M: Clinical guidelines for idiopathic normal pressure hydrocephalus. Neurologia medico-chirurgica 2004; 44: 222-223. – reference: 16) Jobst KA, Smith AD, Szatmari M, Molyneux A, Esiri ME, King E, et al.: Detection in life of confirmed Alzheimer's disease using a simple measurement of medial temporal lobe atrophy by computed tomography. Lancet 1992; 14; 340: 1179-1183. – reference: 2) Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J: The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome. Archives of neurology 1995; 52: 783-789. – reference: 5) Vassilouthis J: The syndrome of normal-pressure hydrocephalus. Journal of neurosurgery 1984; 61: 501-509. – reference: 13) Yamashita F, Sasaki M, Takahashi S, Matsuda H, Kudo K, Narumi S, et al.: Detection of changes in cerebrospinal fluid space in idiopathic normal pressure hydrocephalus using voxel-based morphometry. Neuroradiology 2010; 52 (5): 381-386. Epub 2009 Oct 22. |
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| Snippet | 目的：本邦の特発性正常圧水頭症（以下iNPH）診療ガイドラインでは，possible iNPHの診断基準を満たす症例に対して髄液排除試験を行うよう推奨されている．しかし頭部MRI... |
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| Title | 特発性正常圧水頭症とアルツハイマー型認知症の定量的画像指標の比較 |
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