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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.

Ishikawa M, Yamada S, Yamamoto K - Fluids Barriers CNS (2015)

Bottom Line: No significant changes were noted in basal ganglia VRS.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Rakuwakai Otowa Hospital, 2 Chinji-cho, Otowa, Yamashina-ku, Kyoto, 607-8062, Japan. rakuwadr1001@rakuwadr.com.

ABSTRACT

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.

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Communication of subarachnoid spaces with Virchow–Robin spaces (VRS) in the basal ganglia of a control subject. a Fusion image of coronal plane volume rendering constructive interference in the steady state (CISS) image and magnetic resonance angiography (MRA) image of the basal ganglia. Perivascular CSF spaces were observed around perforating arteries from the M1 portion of the middle cerebral artery (red) in the basal ganglia. They passed upward and then medially to the floor of the lateral ventricle (white arrows). Magnified view of the dotted square (b, c) showed clear continuity of CSF between the subarachnoid space in the basal cistern and VRS in the basal ganglia on CISS (b) and fusion images (c). Observation in a normal 69-year-old man, BG basal ganglia; M1, M2 M1 and M2 portions of the middle cerebral artery; LV lateral ventricle; SF Sylvian fissure, scale bar 5 mm.
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Fig4: Communication of subarachnoid spaces with Virchow–Robin spaces (VRS) in the basal ganglia of a control subject. a Fusion image of coronal plane volume rendering constructive interference in the steady state (CISS) image and magnetic resonance angiography (MRA) image of the basal ganglia. Perivascular CSF spaces were observed around perforating arteries from the M1 portion of the middle cerebral artery (red) in the basal ganglia. They passed upward and then medially to the floor of the lateral ventricle (white arrows). Magnified view of the dotted square (b, c) showed clear continuity of CSF between the subarachnoid space in the basal cistern and VRS in the basal ganglia on CISS (b) and fusion images (c). Observation in a normal 69-year-old man, BG basal ganglia; M1, M2 M1 and M2 portions of the middle cerebral artery; LV lateral ventricle; SF Sylvian fissure, scale bar 5 mm.

Mentions: Virchow–Robin spaces seen in the axial plane were round or tubular and irregularly sized in the basal ganglia (Figure 1a–d). Their diameter ranged from 2 mm to more than 5 mm and their number ranged from <10 to >30 in the basal ganglia. In the coronal plane, VRS were semi-curved tubular structures running upward initially and then curved medially to the floor of the lateral ventricle (Figure 2a, b). Their courses were similar to those of the perforating arteries. Their calibers were often irregular (Figure 2a–d). Enlarged VRS could sometimes be seen as oval pools in the lower part of the basal ganglia. CISS and MRA fusion images showed that VRS communicated with subarachnoid CSF and perforating arteries were seen within some of them (Figures 3, 4). Arteries were most commonly seen in VRS in the lower half of the basal ganglia.Figure 1


Three-dimensional observation of Virchow-Robin spaces in the basal ganglia and white matter and their relevance to idiopathic normal pressure hydrocephalus.

Ishikawa M, Yamada S, Yamamoto K - Fluids Barriers CNS (2015)

Communication of subarachnoid spaces with Virchow–Robin spaces (VRS) in the basal ganglia of a control subject. a Fusion image of coronal plane volume rendering constructive interference in the steady state (CISS) image and magnetic resonance angiography (MRA) image of the basal ganglia. Perivascular CSF spaces were observed around perforating arteries from the M1 portion of the middle cerebral artery (red) in the basal ganglia. They passed upward and then medially to the floor of the lateral ventricle (white arrows). Magnified view of the dotted square (b, c) showed clear continuity of CSF between the subarachnoid space in the basal cistern and VRS in the basal ganglia on CISS (b) and fusion images (c). Observation in a normal 69-year-old man, BG basal ganglia; M1, M2 M1 and M2 portions of the middle cerebral artery; LV lateral ventricle; SF Sylvian fissure, scale bar 5 mm.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4482202&req=5

Fig4: Communication of subarachnoid spaces with Virchow–Robin spaces (VRS) in the basal ganglia of a control subject. a Fusion image of coronal plane volume rendering constructive interference in the steady state (CISS) image and magnetic resonance angiography (MRA) image of the basal ganglia. Perivascular CSF spaces were observed around perforating arteries from the M1 portion of the middle cerebral artery (red) in the basal ganglia. They passed upward and then medially to the floor of the lateral ventricle (white arrows). Magnified view of the dotted square (b, c) showed clear continuity of CSF between the subarachnoid space in the basal cistern and VRS in the basal ganglia on CISS (b) and fusion images (c). Observation in a normal 69-year-old man, BG basal ganglia; M1, M2 M1 and M2 portions of the middle cerebral artery; LV lateral ventricle; SF Sylvian fissure, scale bar 5 mm.
Mentions: Virchow–Robin spaces seen in the axial plane were round or tubular and irregularly sized in the basal ganglia (Figure 1a–d). Their diameter ranged from 2 mm to more than 5 mm and their number ranged from <10 to >30 in the basal ganglia. In the coronal plane, VRS were semi-curved tubular structures running upward initially and then curved medially to the floor of the lateral ventricle (Figure 2a, b). Their courses were similar to those of the perforating arteries. Their calibers were often irregular (Figure 2a–d). Enlarged VRS could sometimes be seen as oval pools in the lower part of the basal ganglia. CISS and MRA fusion images showed that VRS communicated with subarachnoid CSF and perforating arteries were seen within some of them (Figures 3, 4). Arteries were most commonly seen in VRS in the lower half of the basal ganglia.Figure 1

Bottom Line: No significant changes were noted in basal ganglia VRS.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Rakuwakai Otowa Hospital, 2 Chinji-cho, Otowa, Yamashina-ku, Kyoto, 607-8062, Japan. rakuwadr1001@rakuwadr.com.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus