Neuroimage-Based Consciousness Evaluation of Patients with Secondary Doubtful Hydrocephalus Before and After Lumbar Drai
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ORIGINAL ARTICLE
Neuroimage-Based Consciousness Evaluation of Patients with Secondary Doubtful Hydrocephalus Before and After Lumbar Drainage Jiayu Huo1 • Zengxin Qi2,3,4 • Sen Chen1 • Qian Wang1 • Xuehai Wu2,3,4 Di Zang2,3,4 • Tanikawa Hiromi2,3,4 • Jiaxing Tan2,3,4 • Lichi Zhang1 • Weijun Tang5 • Dinggang Shen6,7
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Received: 19 August 2019 / Accepted: 10 March 2020 Ó Shanghai Institutes for Biological Sciences, CAS 2020
Abstract Hydrocephalus is often treated with a cerebrospinal fluid shunt (CFS) for excessive amounts of cerebrospinal fluid in the brain. However, it is very difficult to distinguish whether the ventricular enlargement is due to hydrocephalus or other causes, such as brain atrophy after brain damage and surgery. The non-trivial evaluation of the consciousness level, along with a continuous drainage test of the lumbar cistern is thus clinically important before the decision for CFS is made. We studied 32 secondary mild hydrocephalus patients with different consciousness levels, who received T1 and diffusion tensor imaging magnetic resonance scans before and after lumbar cerebrospinal fluid drainage. We applied a novel machine-learning method to find the most discriminative features from the multi-modal neuroimages. Then, we built a regression model to regress the JFK Coma Recovery Scale-Revised (CRS-R) scores to quantify the level of consciousness. The experimental results showed that our method not only approximated the CRS-R scores but also tracked the temporal changes in
individual patients. The regression model has high potential for the evaluation of consciousness in clinical practice. Keywords Hydrocephalus Disorder of consciousness Structural imaging Feature selection Regression
Introduction Hydrocephalus is a condition in which there is abnormal accumulation of cerebrospinal fluid (CSF) in cavities within the brain. It typically alters the structure as well as the function of many regions. In order to prevent serious complications of developmental, physical, and intellectual impairments, a shunt, such as a ventriculoperitoneal (VP) or lumbar peritoneal (LP) shunt, is often adopted to treat patients with hydrocephalus [1]. It has been shown that brain regions may recover both structure and function after draining the CSF and relieving the intracranial pressure by ventriculostomy and shunt insertion [2]. A recent review suggested that 84.2% of patients with normal-pressure
Jiayu Huo and Zengxin Qi have contributed equally to this work. & Lichi Zhang [email protected]
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State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200030, China
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Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200030, China
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Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Department of Brain and C
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