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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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Related in: MedlinePlus

Absence of an artery in the Virchow–Robin spaces (VRS) in the white matter in a control subject. Multi-planar reconstruction constructive interference in the steady state (CISS) image (black and white) and magnetic resonance angiography (MRA) fusion image (color) in the white matter. CISS image showed VRS as round or tubular structures (circles) at subcortical (a) and periventricular (b) levels. Fusion image did not show any arteries in VRS; observation in a normal 69-year-old man.
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Fig7: Absence of an artery in the Virchow–Robin spaces (VRS) in the white matter in a control subject. Multi-planar reconstruction constructive interference in the steady state (CISS) image (black and white) and magnetic resonance angiography (MRA) fusion image (color) in the white matter. CISS image showed VRS as round or tubular structures (circles) at subcortical (a) and periventricular (b) levels. Fusion image did not show any arteries in VRS; observation in a normal 69-year-old man.

Mentions: In the axial plane, VRS seen in the white matter were homogeneously sized and tubular at the level of the lateral ventricle (Figure 1b, c), and round or oval at the higher level (Figure 1d). VRS were evenly distributed in the white matter but tended to be more numerous posteriorly. Their diameter was ~3 mm with a frequency of >30 per hemisphere. In the coronal and sagittal planes, VRS were tubular with smooth walls (Figure 2). They began at the corticomedullary junctions as pencil-like tips with medial VRS running inferiorly and lateral VRS running horizontally (Figure 2a, b). They did neither penetrate the cortex nor communicate with subarachnoid CSF in 3D images (Figure 5). The length of VRS was variable. Magnified view showed that most of them were short and located mainly near the corticomedullary junction (Figure 5a, b). Some of them were long enough to reach the superolateral angle of the lateral ventricle (Figures 5c, 6). The diameter of VRS was homogeneous in general, but the magnified view showed more dilatation near the corticomedullary junction (Figure 5c). CISS and MRA fusion images showed no perforating arteries within VRS (Figure 7). CISS images showed that the medial ones directed to the superolateral angle of the lateral ventricle and the lateral ones ended at the points lateral to the internal capsule (Figure 6a). CISS and DTI fusion images (Figure 6b) showed VRS in the white matter running parallel to axon tracts, while VRS in the basal ganglia crossed fiber tracts of the internal capsule.Figure 5


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)

Absence of an artery in the Virchow–Robin spaces (VRS) in the white matter in a control subject. Multi-planar reconstruction constructive interference in the steady state (CISS) image (black and white) and magnetic resonance angiography (MRA) fusion image (color) in the white matter. CISS image showed VRS as round or tubular structures (circles) at subcortical (a) and periventricular (b) levels. Fusion image did not show any arteries in VRS; observation in a normal 69-year-old man.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig7: Absence of an artery in the Virchow–Robin spaces (VRS) in the white matter in a control subject. Multi-planar reconstruction constructive interference in the steady state (CISS) image (black and white) and magnetic resonance angiography (MRA) fusion image (color) in the white matter. CISS image showed VRS as round or tubular structures (circles) at subcortical (a) and periventricular (b) levels. Fusion image did not show any arteries in VRS; observation in a normal 69-year-old man.
Mentions: In the axial plane, VRS seen in the white matter were homogeneously sized and tubular at the level of the lateral ventricle (Figure 1b, c), and round or oval at the higher level (Figure 1d). VRS were evenly distributed in the white matter but tended to be more numerous posteriorly. Their diameter was ~3 mm with a frequency of >30 per hemisphere. In the coronal and sagittal planes, VRS were tubular with smooth walls (Figure 2). They began at the corticomedullary junctions as pencil-like tips with medial VRS running inferiorly and lateral VRS running horizontally (Figure 2a, b). They did neither penetrate the cortex nor communicate with subarachnoid CSF in 3D images (Figure 5). The length of VRS was variable. Magnified view showed that most of them were short and located mainly near the corticomedullary junction (Figure 5a, b). Some of them were long enough to reach the superolateral angle of the lateral ventricle (Figures 5c, 6). The diameter of VRS was homogeneous in general, but the magnified view showed more dilatation near the corticomedullary junction (Figure 5c). CISS and MRA fusion images showed no perforating arteries within VRS (Figure 7). CISS images showed that the medial ones directed to the superolateral angle of the lateral ventricle and the lateral ones ended at the points lateral to the internal capsule (Figure 6a). CISS and DTI fusion images (Figure 6b) showed VRS in the white matter running parallel to axon tracts, while VRS in the basal ganglia crossed fiber tracts of the internal capsule.Figure 5

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