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Research ArticleNeuroimaging Physics/Functional Neuroimaging/CT and MRI Technology

Diffusion-Weighted Imaging Reveals Impaired Glymphatic Clearance in Idiopathic Intracranial Hypertension

Derrek Schartz, Alan Finkelstein, Nhat Hoang, Matthew T. Bender, Giovanni Schifitto and Jianhui Zhong
American Journal of Neuroradiology February 2024, 45 (2) 149-154; DOI: https://doi.org/10.3174/ajnr.A8088
Derrek Schartz
aFrom the Department of Imaging Sciences (D.S., A.F., N.H., G.S., J.Z.), University of Rochester Medical Center, Rochester, New York
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  • ORCID record for Derrek Schartz
Alan Finkelstein
aFrom the Department of Imaging Sciences (D.S., A.F., N.H., G.S., J.Z.), University of Rochester Medical Center, Rochester, New York
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Nhat Hoang
aFrom the Department of Imaging Sciences (D.S., A.F., N.H., G.S., J.Z.), University of Rochester Medical Center, Rochester, New York
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Matthew T. Bender
bDepartment of Neurosurgery (M.T.B.), University of Rochester Medical Center, Rochester, New York
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Giovanni Schifitto
aFrom the Department of Imaging Sciences (D.S., A.F., N.H., G.S., J.Z.), University of Rochester Medical Center, Rochester, New York
cDepartment of Neurology (G.S.), University of Rochester Medical Center, Rochester, New York
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Jianhui Zhong
aFrom the Department of Imaging Sciences (D.S., A.F., N.H., G.S., J.Z.), University of Rochester Medical Center, Rochester, New York
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    FIG 1.

    ROI by using atlas-based ALPS index. Top row: The projection (superior and posterior corona radiata, magenta) and association (superior longitudinal fasciculus, yellow) fibers were defined by the labels of the ICBM DTI-81 Atlas. Bottom row: Gray-scale maps of X, Y, and Z diffusion with ROIs.

  • FIG 2.
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    FIG 2.

    A, Association between lumbar puncture opening pressure and Frisen papilledema grade in patients with IIH. B, Association between glymphatic function (ALPS index) and Frisen papilledema grade. The glymphatic clearance on the x-axis is declining moving left to right. C, Association between glymphatic clearance and lumbar puncture opening pressure in patients with IIH. D, Box-and-whisker plot showing difference in glymphatic clearance between patients with IIH and low Frisen grade papilledema (0–2) and lower opening pressure (<50th percentile in cohort) compared with patients with IIH and high Frisen grade papilledema (3–5) and higher opening pressure (≥50th percentile). * indicates P < .05.

  • FIG 3.
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    FIG 3.

    A, Box-and-whisker plot showing glymphatic clearance and how it relates between controls and patients with IIH and varying Frisen papilledema grades. B, Box-and-whisker plot showing difference in glymphatic clearance between controls and patients with IIH and low-grade papilledema (Frisen grade 0–2) and high-grade papilledema (Frisen grade 3–5). * indicates P < .05; ** indicates P < .01.

  • FIG 4.
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    FIG 4.

    ROC curve analysis assessing the diagnostic performance of the ALPS index between patients with IIH versus controls and between patients with IIH and less-severe (Frisen papilledema grade 0–1) and more-severe (Frisen papilledema grade 2–5) disease.

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American Journal of Neuroradiology: 45 (2)
American Journal of Neuroradiology
Vol. 45, Issue 2
1 Feb 2024
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Cite this article
Derrek Schartz, Alan Finkelstein, Nhat Hoang, Matthew T. Bender, Giovanni Schifitto, Jianhui Zhong
Diffusion-Weighted Imaging Reveals Impaired Glymphatic Clearance in Idiopathic Intracranial Hypertension
American Journal of Neuroradiology Feb 2024, 45 (2) 149-154; DOI: 10.3174/ajnr.A8088

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Impaired Glymphatic Clearance in SIH
Derrek Schartz, Alan Finkelstein, Nhat Hoang, Matthew T. Bender, Giovanni Schifitto, Jianhui Zhong
American Journal of Neuroradiology Feb 2024, 45 (2) 149-154; DOI: 10.3174/ajnr.A8088
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