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2015 ; 12
(ä): 15
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Three-dimensional observation of Virchow-Robin spaces in the basal ganglia and
white matter and their relevance to idiopathic normal pressure hydrocephalus
#MMPMID26113079
Ishikawa M
; Yamada S
; Yamamoto K
Fluids Barriers CNS
2015[Jun]; 12
(ä): 15
PMID26113079
show ga
BACKGROUND: Virchow-Robin spaces (VRS) are brain perivascular spaces containing
perforating arteries. Although enlarged VRS are associated with various disorders
such as Alzheimer's disease, cerebrovascular disease, and head trauma, their
functional role remains unclear. Using highly fluid-sensitive magnetic resonance
imaging (MRI) sequences, fine morphological features of VRS and their relevance
to idiopathic normal pressure hydrocephalus (iNPH) were investigated. METHODS:
Three-dimensional constructive interference in steady state (3D-CISS) on 3 Tesla
MRI was applied to 29 individuals. The morphology and number of VRS in the basal
ganglia and white matter were compared between 20 patients with iNPH and nine
age-matched controls. The VRS number per hemisphere was classified into three
grades: few, moderate, and abundant. RESULTS: Virchow-Robin spaces in the basal
ganglia were curved, irregularly sized and shaped, and communicated with the
cerebrospinal fluid in the subarachnoid space; they contained perforating
arteries. VRS in the white matter were straight, smooth, homogeneously sized and
shaped, and did not penetrate the cortex. Arteries were not seen in VRS of the
white matter. White matter VRS were sparse in patients with iNPH. In contrast,
basal ganglia VRS positively correlated with age. Postoperatively after shunt
surgery, VRS in the white matter were mildly decreased in diameter, but not in
number. No significant changes were noted in basal ganglia VRS. CONCLUSIONS: The
present study revealed different morphological features of VRS in the basal
ganglia and white matter. VRS in the basal ganglia were seen as genuine
perivascular spaces; while neither communication with subarachnoid spaces nor
arteries were seen in white matter VRS, even by 3D-CISS sequences and
high-resolution magnetic resonance angiography on 3T-MRI. White matter VRS were
sparse in patients with iNPH and they were mildly decreased in diameter, but did
not change in number after surgery. At present, it remains unclear whether the
white matter VRS are dilated interstitial fluid spaces or cerebral amyloid
angiopathy, or both. Further studies are necessary to elucidate the functional
role of VRS in normal subjects and patients with iNPH.