European Radiology

, Volume 28, Issue 11, pp 4504–4513 | Cite as

Changes in sensorimotor-related thalamic diffusion properties and cerebrospinal fluid hydrodynamics predict gait responses to tap test in idiopathic normal-pressure hydrocephalus

  • Ping-Huei Tsai
  • Yung-Chieh Chen
  • Shih-Wei Chiang
  • Teng-Yi Huang
  • Ming-Chung Chou
  • Hua-Shan Liu
  • Hsiao-Wen Chung
  • Giia-Sheun Peng
  • Hsin-I Ma
  • Hung-Wen Kao
  • Cheng-Yu ChenEmail author
Magnetic Resonance



To compare diffusion tensor (DT)-derived indices from the thalamic nuclei and cerebrospinal fluid (CSF) hydrodynamic parameters for the prediction of gait responsiveness to the CSF tap test in early iNPH patients.


In this study, 22 patients with iNPH and 16 normal controls were enrolled with the approval of an institutional review board. DT imaging and phase-contrast magnetic resonance imaging were performed in patients and controls to determine DT-related indices of the sensorimotor-related thalamic nuclei and CSF hydrodynamics. Gait performance was assessed in patients using gait scale before and after the tap test. The Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were applied to compare group differences between patients and controls and assess the predictive performance of gait responsiveness to the tap test in the patients.


Fractional anisotropy (FA) and axial diffusivity showed significant increases in the ventrolateral (VL) and ventroposterolateral (VPL) nuclei of the iNPH group compared with those of the control group (p < 0.05). The predictions of gait responsiveness of ventral thalamic FA alone (area under the ROC curve [AUC] < 0.8) significantly outperformed those of CSF hydrodynamics alone (AUC < 0.6). The AUC curve was elevated to 0.812 when the CSF peak systolic velocity and FA value were combined for the VPL nucleus, yielding the highest sensitivity (0.769) and specificity (0.778) to predict gait responses.


Combined measurements of sensorimotor-related thalamic FA and CSF hydrodynamics can provide potential biomarkers for gait response to the CSF tap test in patients with iNPH.

Key Points

Ventrolateral and ventroposterolateral thalamic FA may predict gait responsiveness to tap test.

Thalamic neuroplasticity can be assessed through DTI in idiopathic normal-pressure hydrocephalus.

Changes in the CST associated with gait control could trigger thalamic neuroplasticity.

Activities of sensorimotor-related circuits could alter in patients with gait disturbance.

Management of patients with iNPH could be more appropriate.


Hydrocephalus, normal pressure Diffusion tensor imaging Gait Neuronal plasticity Thalamus 



Cerebrospinal fluid


Corticospinal tract


Axial diffusivity


Radial diffusivity


Diffusion tensor imaging


Fractional anisotropy


Idiopathic normal pressure hydrocephalus


Mean diffusivity









We acknowledge Wallace Academic Editing for editing this manuscript.


This study has received funding by grants from the Ministry of Science and Technology, Taipei, Taiwan, grant NSC 97-2314-B-016-028-MY3 and grant MOST 106-2221-E-038-002.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Cheng-Yu Chen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• observational

• performed at one institution

Supplementary material

330_2018_5488_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Ping-Huei Tsai
    • 1
    • 2
  • Yung-Chieh Chen
    • 3
    • 4
  • Shih-Wei Chiang
    • 5
  • Teng-Yi Huang
    • 6
  • Ming-Chung Chou
    • 7
  • Hua-Shan Liu
    • 8
  • Hsiao-Wen Chung
    • 9
  • Giia-Sheun Peng
    • 10
  • Hsin-I Ma
    • 11
  • Hung-Wen Kao
    • 5
  • Cheng-Yu Chen
    • 3
    • 4
    • 12
    Email author
  1. 1.Department of Medical Imaging and Radiological SciencesChung Shan Medical UniversityTaichungTaiwan
  2. 2.Department of Medical ImagingChung Shan Medical University HospitalTaichungTaiwan
  3. 3.Research Center of Translational Imaging, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  4. 4.Department of Medical ImagingTaipei Medical University Hospital, Taipei Medical UniversityTaipeiTaiwan
  5. 5.Department of RadiologyTri-Service General Hospital and National Defense Medical CenterTaipeiTaiwan
  6. 6.Department of Electrical EngineeringNational Taiwan University of Science and TechnologyTaipeiTaiwan
  7. 7.Department of Medical Imaging and Radiological SciencesKaohsiung Medical UniversityKaohsiungTaiwan
  8. 8.School of Biomedical Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan
  9. 9.Graduate Institute of Biomedical Electronics and BioinformaticsNational Taiwan UniversityTaipeiTaiwan
  10. 10.Department of NeurologyTri-Service General Hospital and National Defense Medical CenterTaipeiTaiwan
  11. 11.Department of Neurological SurgeryTri-Service General Hospital and National Defense Medical CenterTaipeiTaiwan
  12. 12.Department of Radiology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan

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