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Home , Lateral ventricles, Third ventricle

Rev Bras Neurol. 53(3):41-46, 2017 AGE-RELATED CEREBRAL VENTRICULAR VOLUME CHANGES IN HEALTHY ELDERLY HUMANS

ALTERAÇÕES VOLUMÉTRICAS DOS VENTRÍCULOS CEREBRAIS RELACIONADAS A IDADE EM IDOSOS SAUDÁVEIS

Mário Luciano de Mélo Silva Júnior1,2, Paula Rejane Beserra Diniz1,3, Daniella Araújo de Oliveira1,4, Luciana Patrizia Alves de Andrade Valença1,2,5, Antonio Carlos dos Santos6, Marcelo Moraes Valença1,5

ABSTRACT RESUMO Introduction: Normal aging is associated with morphological alte- Introdução: O envelhecimento normal está associado a alterações UDWLRQVLQEUDLQ9HQWULFXODUV\VWHPLVORFDWHGGHHSLQVLGHEUDLQDQG morfológicas do cérebro. O sistema ventricular está localizado pro- UHȵHFWWKHRYHUDOOSURFHVVRISDUHQFK\PDODWURSK\2QFHQHXURGH- IXQGDPHQWHQRHQF«IDORHUHȵHWHRSURFHVVRJOREDOGHDWURȴDGRSD- generative disorders course with more prominent dilatation of rênquima. Uma vez que doenças neurodegenerativas cursam com YHQWULFOHVWRHVWDEOLVKQRUPDWLYHYROXPHWULFSDUDPHWHUVIURP%UD]L- dilatação mais proeminente dos ventrículos cerebrais, estabelecer lian healthy old individuals is necessary, and it may be an additional SDU¤PHWURVYROXP«WULFRVGHQRUPDOLGDGHHPQRVVDSRSXOD©¥RLGRVD WRRORQGL΍HUHQWLDWLRQIURPWKHQRUPDOWRSDWKRORJLFDOObjective: To saudável se faz necessário, podendo ser uma ferramenta a mais para LQYHVWLJDWHEUDLQYHQWULFXODUYROXPHFKDQJHVLQ%UD]LOLDQKHDOWK\HO- diferenciar o normal do patológico. Objetivo: Investigar alterações derly people. Methods: Transversal study using magnetic resonance volumétricas dos ventrículos cerebrais em brasileiros idosos sau- LPDJLQJ 7 RIWKHEUDLQIURPHOGHUO\KHDOWK\YROXQWHHUV s dáveis. Métodos: (VWXGR WUDQVYHUVDO FRP LPDJHQV GH UHVVRQ¤QFLD \HDUV ROG  'DWD ZHUH DVVHVVHG ZLWK PDQXDO VHJPHQWDWLRQ WHFKQL- PDJQ«WLFD 7 GRHQF«IDORGHLGRVRVVDXG£YHLV sDQRV que. Regions of interest were the brain ventricles and intracranial PXOKHUHV 2VGDGRVIRUDPH[DPLQDGRVSRUW«FQLFDVGHVHJPHQWD- YROXPHV2OG \HDUVROGZRPHQ DQG2OGHU !\HDUVROG  ção manual. As regiões de interesse foram os ventrículos cerebrais groups were created for analysis. Results9ROXPHRIDOOYHQWULFXODU HRYROXPHLQWUDFUDQLDQR&ULDPRVRVVXEJUXSRVΖGRVRV DQRV  FRPSDUWPHQWVVLJQLȴFDQWO\LQFUHDVHG S  ZLWKDJHZLWKH[FHS- H0DLVLGRVRV !DQRV SDUDDDQ£OLVHResultados: O volume de tion of the . The third and increased WRGRVRVYHQWU¯FXORVDXPHQWRXFRPDLGDGH S  FRPH[FH©¥R EHWZHHQJURXSVDQGIROGUHVSHFWLYHO\0HDQWRWDOYHQWULFXODU do quarto ventrículo. O terceiro e os ventrículos laterais aumentaram YROXPHZDVsRILQWUDFUDQLDOYROXPHLQ2OGDQGsLQ2O- HYH]HVUHVSHFWLYDPHQWHHQWUHRVJUXSRV2YROXPHYHQWUL- GHUJURXS S  ZKLFKUHSUHVHQWVsPODQGsPO S   FXODUP«GLRIRLGHsGRYROXPHLQWUDFUDQLDQRQRVΖGRVRVH respectively. We observed a moderate to strong positive correlation GHsQRVPDLVLGRVRVRTXHUHSUHVHQWDsPOHsPO between ventricular volume and age, with the best correlation in the respectivamente. Observamos correlação positiva de moderada a WKLUGYHQWULFOH U  7RWDOLQWUDFUDQLDOYROXPHGLPLQLVKHGZLWKDJH forte entre volume ventricular e idade, com a melhor correlação no EXWZLWKRXWVWDWLVWLFDOVLJQLȴFDQFHConclusions%UDLQYHQWULFOHVYR- WHUFHLURYHQWU¯FXOR U  2YROXPHLQWUDFUDQLDQRGLPLQXLFRPD OXPHLQFUHDVHGVLJQLȴFDQWO\ZLWKDJHLQKHDOWK\ROGLQGLYLGXDOVZLWK LGDGHVHPVLJQLȴF¤QFLDHVWDW¯VWLFDConclusão: os ventrículos cere- exception of the fourth ventricle. EUDLVDXPHQWDPVLJQLȴFDWLYDPHQWHFRPRHQYHOKHFLPHQWRHPLGRVRV saudáveis, exceto o quarto ventrículo. Keywords: EUDLQ DWURSK\ WKLUG YHQWULFOH IRXUWK YHQWULFOH DJLQJ magnetic resonance imaging Palavras-chave:DWURȴDFHUHEUDOWHUFHLURYHQWU¯FXORTXDUWRYHQWU¯- FXORHQYHOKHFLPHQWRLPDJHPSRUUHVVRQ¤QFLDPDJQ«WLFD

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Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 41 Junior MLMS et al. INTRODUCTION METHODS %UDLQLVDG\QDPLFRUJDQDQGLWVGLPHQVLRQVYDU\ Volunteers LQ WKH OLIHVSDQ RI KHDOWK\ LQGLYLGXDOV 7KH YROXPH UH :HDVVHVVHGPDJQHWLFUHVRQDQFHLPDJHVIURP GXFWLRQUDWHVGXULQJWKHDJLQJSURFHVVDUHGL൵HUHQWLQWKH %UD]LOLDQYROXQWHHUVRYHU\HDUVRIDJH “\HDUV YDULRXVDUHDVRIWKHEUDLQDQGLQFUHDVHZLWKDJHWKHDWUR  ZRPHQ  LQ D FURVVVHFWLRQDO VWXG\ 7KHVH VXEMHFWV SK\EHLQJPRUHLQWHQVHLQWKHSDULHWDOSUHIURQWDODQGWHP ZHUHFRQVLGHUHGKHDOWK\EDVHGRQFOLQLFDODQGODERUDWRU\ SRUDODUHDVWKDQLQWKHRFFLSLWDODUHD5RXWLQHO\YLVXDO ¿QGLQJV ,PDJHV IURP SDWLHQWV ZLWK D KLVWRU\ RI FHQWUDO DQGOLQHDUHYDOXDWLRQRIEUDLQLPDJLQJLVFRPPRQO\XVHG QHUYRXVV\VWHPGLVHDVHWUDXPDWLFEUDLQLQMXU\SV\FKLDWULF WRLGHQWLI\FKDQJHVLQERWKSDUHQFK\PDDQGYHQWULFOHVDV GLVRUGHUV FKURQLF DOFRKROLVP GHOLULXP *+ GH¿FLHQF\ WKLV TXDOLWDWLYH W\SH RI DSSURDFK LV DQ HDV\ DQG UHOLDEOH DQHPLD DFXWH P\RFDUGLXP LQIDUFWLRQ DQG XQFRQWUROOHG PHWKRGLQWKHKDQGVRIZHOOWUDLQHGUDGLRORJLVWV2QWKH K\SHUWHQVLRQZHUHH[FOXGHGDVZHOOWKRVHZLWKDKLVWRU\ RWKHUKDQGTXDQWLWDWLYHYROXPHWULFVWXGLHVDUHPRUHDFFX RIXVHRIFHQWUDOQHUYRXVV\VWHPDFWLRQGUXJV UDWHLQGHWHFWLQJVXEWOHFKDQJHVDQGDUHKLJKO\LPSRUWDQW LQWKHH[SHULPHQWDOHYDOXDWLRQRIVSHFL¿FGL൵HUHQFHVEH Magnetic resonance imaging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anual segmentation process and anatomical DJLQJSURFHVV7KHUHLVDFRQVHQVXVWKDWLQROGSHRSOHWKH limits HQODUJHPHQWRIEUDLQYHQWULFOHVRFFXUVDVDJHLQFUHDVHVDQG 7KH PDQXDO VHJPHQWDWLRQ ZDV SHUIRUPHG HP LWUHÀHFWVDWURSK\LQWKHHQWLUHSDUHQFK\PD SOR\LQJ 'LVSOD\ VRIWZDUH 0F*LOO 8QLYHUVLW\ 7KLV VRI 9ROXPHWU\RIWKHEUDLQYHQWULFOHVDVDQLQYHVWLJDWL WZDUH DOORZV DVVHVVLQJ WKH UHJLRQV RI LQWHUHVW 52,V  LQ YHWHFKQLTXHSUREDEO\EHJDQZLWKWKHSRVWPRUWHPVWXGLHV WKHWKUHHDQDWRPLFDOSODQHVDQGLQDYR[HOE\YR[HOPD RI+DUYH\6XEVHTXHQWO\in vivoGDWDIURPFRPSXWHGWR QXDOWHFKQLTXHZKLFKUHVXOWVLQDPRUHSUHFLVHVWXG\7RWDO PRJUDSK\ZHUHXVHGEXWWKHUHZHUHVWLOOVRPHOLPLWDWLRQV LQWUDFUDQLDOYROXPH ,&9 ZDVFDOFXODWHGIURPPDJQXP WKDWPD\ELDVGDWDSUHFLVLRQ7KHUHLVQRZJHQHUDODJUHH IRUDPHQWRYHUWH[7KHYROXPHLVDXWRPDWLFDOO\FDOFXODWHG PHQWWKDWPDJQHWLFUHVRQDQFHLPDJLQJSURYLGHVWKHEHVW EDVHG RQ WKH QXPEHU RI YR[HOV VHJPHQWHG DV 52,$JH UHODWLRQVKLSEHWZHHQDQDWRPLFDOUHSUHVHQWDWLRQDQGLPD DQGJHQGHURIWKHYROXQWHHUVZHUHEOLQGHGWRWKHREVHUYHU JLQJGH¿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¶VIRUDPHQZDVFODVVL¿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¶VGLVHDVH

42 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 Brain ventricles volumetry in healthy elderly humans

Statistical analysis Table 1 – Linear regression and correlation of corrected volume vs. age %DVHGRQDJHZHFUHDWHGWZRJURXSV2 2  \HDUV ROG “ Q    ZRPHQ  DQG ³ROGHU´ Lateral Variable Third Fourth TVV 22\HDUVROG“Q ZRPHQ :HXVHG Left Right Both OLQHDU UHJUHVVLRQ DQG 3HDUVRQ¶V RU 6SHDUPDQ¶V FRUUHOD Slope F 15.2 16.5 14.5 26.9 0.9 16.7 WLRQWRDVVHVVFKDQJHVLQYHQWULFOHYROXPHVZLWKDJHDQG Linear p .001 < .001 .001 < .001 .369 < .001 0DQQ:KLWQH\¶VRU6WXGHQW¶VWWHVWIRUJURXSFRPSDULVRQV regression DQGFRQVRQDQWDSSOLFDELOLW\'DWDDQDO\VLVZDVSHUIRUPHG r² .444 .465 .434 .587 .043 .468 XVLQJ*UDSK3DG3ULVPVRIWZDUH$VLJQL¿FDQFHOHYHORI r .542 .612 .559 .710 .207 .596 ZDVDGRSWHG Correlation ,Q RUGHU WR PLQLPL]H WKH YROXQWHHUV LQGLYLGXDO p .011 .003 .008 < .001 .369 .004 DQDWRPRSK\VLRORJLFDOQRUPDOYDULDELOLWLHVZHXVHGFRU r = Spearman. For Fourth ventricle, Pearson correlation was used. TVV = total ventricular volume. UHFWHGYROXPHVi.e.52,DEVROXWHYROXPHSHUFHQWDJHRI WKH WRWDO ,&9 FRUUHFWHG YROXPH  52, YROXPH [   Table 2 – Linear regression and correlation of absolute volume vs. age

,&9 7KHGDWDDUHH[SUHVVHGDVPHDQ“VWDQGDUGGHYLD Lateral WLRQ Variable Third Fourth TVV Left Right Both

Slope F 13.1 15.5 14.5 19.7 0.3 14.7 Ethical aspects Linear p .001 < .001 .001 < .001 .569 .001 7KLVVWXG\ZDVDSSURYHGE\)HGHUDO8QLYHUVLW\RI regression 3HUQDPEXFR¶V(WKLFV&RPPLWWHH$OOYROXQWHHUVJDYHWKHLU r² .408 .449 .434 .509 .017 .437 LQIRUPHGDJUHHPHQWWRSDUWLFLSDWH r .479 .579 .559 .651 .132 .566 Correlation p .030 .006 .008 .001 .569 .007 RESULTS r = Spearman. For Fourth ventricle, Pearson correlation was used. TVV = total ventricular volume. Reliability 7KUHHPRQWKVDIWHUWKH¿UVWVHJPHQWDWLRQZHUDQ 7KHDEVROXWHYROXPHVRIWKH//95/9DQG%/9 GRPO\UHDVVHVVHGRIRXUVDPSOHDQGREVHUYHGDQLQ FRPSDUWPHQWVZHUHVLJQL¿FDQWO\ODUJHULQWKH22JURXS WUDREVHUYHUFRUUHODWLRQRI &, S < 7DEOH DQGDOVRKDGDSRVLWLYHFRUUHODWLRQZLWKDJH 7DE 6SHDUPDQ  OH 7KHPHDQDEVROXWHYROXPHVZHUHPOPODQG POIRU//95/9DQG%/9UHVSHFWLYHO\ Total intracranial volume 7KH LQWUDFUDQLDO WRWDO YROXPH PHDQ ZDV KLJKHU LQ WKH 2 JURXS EXW ZLWK QR VWDWLVWLFDO VLJQL¿FDQFH 2 7KLUGYHQWULFOHDOWKRXJKDVPDOODQGGL൶FXOW52, “ PO 22 “ PO S   6WXGHQW¶V LQPDQXDOVHJPHQWDWLRQVKRZHGDQLQWUDREVHUYHUFRUUH WWHVW  7KH FRUUHODWLRQ DJH YV WRWDO LQWUDFUDQLDO YROXPH ODWLRQRI &,S 3HDUVRQ 7KH ZDVZHDNO\QHJDWLYHDOVRZLWKRXWVWDWLVWLFDOVLJQL¿FDQFH DEVROXWHDQGFRUUHFWHGYROXPHVRIWKLV52,ZHUHDQG U S 6SHDUPDQ  IROGUHVSHFWLYHO\DQGODUJHULQWKH22JURXS 7DEOH   ZLWK VWDWLVWLFDO VLJQL¿FDQFH &RUUHFWHG YROXPH OLQHDU Lateral ventricles UHJUHVVLRQZDVVLJQL¿FDQWO\DQGVWURQJO\SRVLWLYHO\FRUUH :HREVHUYHGWKDWWKHUHZDVDVWDWLVWLFDOO\VLJQL¿ ODWHGZLWKDJH 7DEOH 5HJDUGLQJWKHLQGLYLGXDOVWKH FDQWO\SRVLWLYHFRUUHODWLRQEHWZHHQWKHFRUUHFWHGYROXPH PHDQDEVROXWHYROXPHZDV“PO RIWKHODWHUDOYHQWULFOHVDQGDJH 7DEOH :KHQZHFRP SDUHGFRUUHFWHGYHQWULFXODUYROXPHVEHWZHHQDJHJURXSV Fourth ventricle //9ZDVLQVLJQL¿FDQWO\VPDOOHUWKDQWKH5/9 YV 7KLV 52, LV DOVR GL൶FXOW WR PDQXDOO\ VHJPHQW S :LOFR[RQ DQGZHQRWLFHGDDQG EXWVKRZHGDQLQWUDREVHUYHUFRUUHODWLRQRI &, IROG YROXPH LQFUHDVH EHWZHHQ 2 DQG 22 JURXSV LQ WKH S 3HDUVRQ ,QVSLWHRIWKHIRXUWKYHQ 5/9//9DQG%/9 7DEOH  WULFOHKDYLQJVKRZQDQHQODUJHPHQWZLWKDJLQJ 7DEOHV

Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 43 Junior MLMS et al.

WR LQFRUUHFWHGDQGDEVROXWHYROXPHVLWZDVWKHRQO\ ODUFRPSDUWPHQWVLQ%UD]LOLDQV6WXGLHVRQWKH%UD]LOLDQ YHQWULFXODUFRPSDUWPHQWWKDWGLGQRWDWWDLQVWDWLVWLFDOVLJ SRSXODWLRQ DUH LPSRUWDQW VLQFH HQYLURQPHQWDO WR[LF DQG QL¿FDQFHLQDQ\RIRXUDQDO\VHV HWKQLFIDFWRUVPD\EHDVVRFLDWHGZLWKYHQWULFXODUYROXPH FKDQJHV)XUWKHUPRUHRWKHUVFRQFOXGHGWKDWLQGLYLGXDO Total ventricular volume JHQHWLFVSOD\VDFHQWUDOUROHLQYHQWULFXODUYROXPHLQFUHDVH 7RWDOYHQWULFXODUYROXPH 799 ZDVWKHVXPRI LQHOGHUO\SHRSOH DOOYHQWULFXODUFRPSDUWPHQWV7KLV52,VKRZHGLQFUHDVHV :HVKRZDVLJQL¿FDQWHQODUJHPHQWLQDOOYHQWULFX RIDQGIROGUHVSHFWLYHO\LQFRUUHFWHGDQGDEVR ODUFRPSDUWPHQWVH[FHSWIRUWKHIRXUWKYHQWULFOH6LPLODU OXWHYROXPHVZKHQZHFRPSDUHG2ZLWK22JURXSV7KLV ¿QGLQJV DQG DOVR DQ LQVLJQL¿FDQW UHGXFWLRQ LQ IRXUWK HQODUJHPHQWZDVVWDWLVWLFDOO\VLJQL¿FDQWLQFRUUHODWLRQDQG YHQWULFOHYROXPHWKURXJKRXWOLIHKDYHEHHQGHVFULEHG7KH OLQHDUUHJUHVVLRQZLWKDPRGHUDWHDVVRFLDWLRQEHWZHHQDJH IRXUWKYHQWULFOHPD\EHOHVVVXVFHSWLEOHWRDWURSK\VLQFHLW DQGYROXPHLQFUHPHQW:HREVHUYHGWKDWWKHUHZDVDQHQ KDVDGLUHFWUHODWLRQVKLSZLWKROGHUHYROXWLRQDU\VWUXFWXUHV ODUJHPHQWRIDURXQGPOSHU\HDULQRXUVDPSOH)LJXUH RUDVLWLVWKHRQO\YHQWULFOHORFDWHGLQWKHSRVWHULRUIRVVD VXPPDUL]HVRXUGDWD WKLVUHJLRQPD\FUHDWHDGL൵HUHQWÀXLGG\QDPLFRUH[SUHVV D SUHGRPLQDQWO\ ORQJLWXGLQDO UDWKHU WKDQ Table 3 – Old vs. Older groups comparisons for corrected and absolute volume FHQWULIXJDO SDWWHUQRIDWURSK\RUWKHVXPRI Lateral ventricles Group Third Fourth TVV WKHVHK\SRWKHVHV0RUHVWXGLHVDUHUHTXLUHG Left Right Both WRIXUWKHUXQGHUVWDQGWKLVPDWWHU O 0.48±0.22 0.52±0.24 0.99±0.44 0.06±0.02 0.09±0.02 1.2±0.45 Corrected 7KH YROXPH RI WKH WKLUG YHQWULFOH OO 1.5±.88 1.5±.86 3.0±1.7 0.14±.05 0.11±.03 3.2±1.8 volume VKRZHGWKHEHVWFRUUHODWLRQLQERWKFRUUHF p < .001 < .001 < .001 < .001 .216 < .001 WHGDQGDEVROXWHYROXPHVYVDJHLQRXUGDWD O 6.3±3.2 6.8±3.2 13.1±6.2 .82±.33 1.2±.3 15.1±6.4 Absolute OO 18.3±11.9 18.2±11.1 36.4±22.9 1.7±.7 1.3±.5 39.5±23.8 ,QVXSSRUWWRWKLVVWXGLHVKDYHVKRZQDQLQ volume  p .002 .001 .001 .001 .439 .001 WHQVHWKDODPLFDWURSK\LQKHDOWK\DJLQJ  p = Student’s t test. Absolute volume in ml. DQGWKHEHVWFRUUHODWLRQEHWZHHQYHQWULFXODU FRPSDUWPHQW DQG DJH HVSHFLDOO\ LQ PHQ $VVHVVLQJ WKLV VWUXFWXUH PD\ EH DQ LPSRU DISCUSSION WDQWWRROLQWKHHYDOXDWLRQRIDJLQJLWLVDUHODWLYHO\VPDOO :H DVVHVVHG EUDLQ YHQWULFOHV IRU WKH SXUSRVH RI 52,ZLWKDVKRUWWLPHRIVHJPHQWDWLRQDQGKDVDQH[FHOOHQW HYDOXDWLQJWKHDJLQJH൵HFWVRQWKHVHVWUXFWXUHVDQGLGHQWL LQWUDFODVV FRUUHODWLRQ ,Q DGGLWLRQ RWKHUV KDYH VKRZQ I\LQJZKLFKRQHKDVWKHEHVWFRUUHODWLRQZLWKWKHKHDOWK\ WKDWWKHVL]HRIWKHWKDODPXVGLGQRWGL൵HULQIXQFWLRQRIFH DJLQJSURFHVV2XUGDWDVKRZHGWKDWEUDLQYHQWULFOHVHQODU UHEUDOGRPLQDQWVLGHRUVH[7KHVHGDWDFRQYHUJHWRGUDZ JHZLWKDJH/DWHUDOYHQWULFOHVDUHDV\PPHWULFDODQG5/9 PRUHDWWHQWLRQWRWKLUGYHQWULFOHYROXPHDVDQLPSRUWDQW LVVOLJKWO\ODUJHUWKDQ//97KHWKLUGYHQWULFOHVKRZHGWKH SDUDPHWHULQWKHHYDOXDWLRQRIKHDOWK\DJLQJ EHVWFRUUHODWLRQZLWKDJHLQDEVROXWHDQGFRUUHFWHGYROXPH 6RPH VWXGLHV UHSRUW VLJQL¿FDQW DV\PPHWU\ LQ PHDVXUHPHQWVDQGWKHIRXUWKYHQWULFOHZDVWKHRQO\FRP EUDLQVWUXFWXUHVSUREDEO\VHFRQGDU\WRODWHUDOL]HGIXQF SDUWPHQWLQZKLFKVWDWLVWLFDOVLJQL¿FDQFHZDVQRWREVHU WLRQVZKLOHRWKHUVGRQRW,QRXUGDWDODWHUDOYHQWULFOHV YHG7KHXVHRIFRUUHFWHGYROXPHWULFGDWDSURYLGHGDEHWWHU VKRZHG D VOLJKW DV\PPHWU\ LQ ZKLFK WKH OHIW VLGH ZDV ¿WQHVVLQOLQHDUUHJUHVVLRQVWKDQDEVROXWHPHDVXUHPHQWV VPDOOHUWKDQWKHULJKWKRZHYHULQWKHOLWHUDWXUHERWKVLPL %UDLQK\SRWURSK\LVDSK\VLRORJLFDQGPXOWLIDF ODUDQGRSSRVLWH¿QGLQJVDUHIRXQG$OWKRXJKWKHUHDUH WRULDO SURFHVV DQG FRXUVHV ZLWK SURSRUWLRQDO YHQWULFXODU DV\PPHWULHV UHVHDUFKHUV KDYH VKRZQ WKDW DJLQJ H൵HFWV GLODWDWLRQ7KLVK\SRWURSK\LVVHFRQGDU\WRQHXURQDOVL]H DUHHTXDORQERWKVLGHVLQVXSSRUWRIWKDWRXUGDWDVKRZ FRQWUDFWLRQDFWLYDWLRQRIJOLDDQGV\QDSWLFGLPLQLVKLQJ D GL൵HUHQFH RI OHVV WKDQ  EHWZHHQ UVFRUHV  YV P\HOLQ ORVV DQG  GHSRVLWLRQ RI QHXUR¿EULOODU\ WDQJOHV DQGYVIRUFRUUHFWHGDQGDEVROXWHYROXPH :HIRXQGDVLJQL¿FDQWLQFUHDVHLQWKHYROXPHRIWKHEUDLQ RIOHIWDQGULJKWODWHUDOYHQWULFOHVUHVSHFWLYHO\ :KLOHGL YHQWULFXODUV\VWHPLQKHDOWK\HOGHUO\SHRSOH7KLV¿QGLQJV ൵HUHQWSDUHQFK\PDODUHDVKDYHGLVWLQFWUDWHVRIDWURSK\ KDVDOUHDG\EHHQGHVFULEHGE\RWKHUVEXWZHGLGQRW WKHSRVLWLRQRIWKHYHQWULFOHVDQGWKHLUSODVWLFLW\WRJURZ ¿QG DQ\ VWXG\ IRFXVLQJ RQ WKHHQODUJHPHQWRI YHQWULFX LQDQ\GLUHFWLRQGHSHQGLQJRQWKHWLVVXHLQFRQWDFWZLWK

44 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 Brain ventricles volumetry in healthy elderly humans

WKHPWHQGVWRVPRRWKWKRVHGL൵HUHQFHVDQGUHSUHVHQWWKH UHLVQRPDOHIHPDOHUDWLRWKDWSUHYHQWHGDQDQDO\VLV RYHUDOOSURFHVVRIDJLQJ SDUHQFK\PDODWURSK\DQGYHQWUL E\ VH[ 6H[UHODWHG GL൵HUHQFHV LQ EUDLQ VWUXFWXUHV LV QRW FXODUV\VWHPGLODWDWLRQ $OVRUHSRUWVVKRZDQLQFUHDVH XQDQLPRXVDJRRGH[DPSOHRIWKLVLVWKDW(YDQ¶VLQGH[ LQ YHQWULFXODU YROXPH SULRU WR GHWHFWDEOH FKDQJHV LQ WKH DPHDVXUHIRUQRUPDOSUHVVXUHK\GURFHSKDOXVGRHVQRW SDUHQFK\PD FRQVLGHUVH[ 7RWDOYHQWULFXODUYROXPHLVRIWHQDVVHVVHGE\UH VHDUFKHUV DQG VLPLODU UHVXOWV KDYH EHHQ REWDLQHG 7DEOH Table 4 – Ventricular volumes (absolute in ml and corrected in %) in different studies  ,QGHHGWKHPDLQYDULDEOHDVVRFLDWHGZLWKGL൵HUHQWUH Reference n Age Techinique TVV CVV Amarki et al. VXOWVZDVDJHEXWWKHPDOHIHPDOHUDWLRDQGPHWKRGROR 46 71.0±6.0 RM 3.0 T – Manual 37.0±18.0 2.5±1.2 2010 JLFDOGL൵HUHQFHVPD\\LHOGGLVFUHSDQWYROXPHV2XUGDWD Blatter et al., 15 59.8±2.2 RM 1.5 T – Manual 24.2±12.2 – RQ799ZDVFRPSDUDEOHZLWKWKDWRIRWKHUVDQGLVDQex 1995* Matsumae et 22 72.0±5.0 RM 1.5 T – Semiautomatic 33.0±10.0 2.4±0.6 YDFXRH൵HFWRISDUHQFK\PDODWURSK\HYHQLQKHDOWK\VXE al., 1996 Carmichael et MHFWV6WXGLHVVXJJHVWWKDWLQSDWKRORJLFDOFRQGLWLRQVVXFK 52 83.6±4.4 RM 1.5 T – Automatic 30.7±12.6 – al., 2010# DV$O]KHLPHUV WKH WLVVXH ORVV LV PRUH SURPLQHQW DQG D Resnick et al., 63 64.6±3.2 RM 1.5 T - Semiautomatic 25.2±10.8 – FRQVHTXHQWO\JUHDWHUYHQWULFXODUHQODUJHPHQWWKLVPDNHV 2000 QRUPDWLYHGDWDUHOHYDQWLQGL൵HUHQWLDWLQJWKHSK\VLRORJLFDO This study 21 67.7±6.3 RM 1.5 T - Manual 22.1±17.3 1.8±1.4 TVV = total ventricular volume; CVV = corrected ventricular volume. *Only women DJLQJSURFHVVIURPSDWKRORJLFDOFKDQJHVRIEUDLQWLVVXH data were used. #Prospectively healthy subjects. $OVRTXDQWLWDWLYHDQDO\VLVRIQHXURLPDJLQJLVSURJUHVVL YHO\DFTXLULQJPRUHGLDJQRVWLFYDOXH&RQVRQDQWZLWK CONCLUSIONS RWKHUDXWKRUVWKHUHLVQRVLJQL¿FDQWFKDQJHLQWRWDO,&9 +HDOWK\ DJLQJ RFFXUV ZLWK D VLJQL¿FDQW HQODUJH $V OLPLWDWLRQV RXU VDPSOH DOWKRXJK TXDQWLWD PHQWRIWKHEUDLQYHQWULFOHV$OOYHQWULFXODUFRPSDUWPHQWV WLYHO\VLPLODUWRWKDWRIRWKHUVLVDVPDOORQHDQGPD\ H[FHSWIRUWKHIRXUWKYHQWULFOHLQFUHDVHLQYROXPH QRWUHSUHVHQWWKHHQWLUHHOGHUO\SRSXODWLRQ/LNHZLVHWKH

Figure 1. Linear regressions of both lateral, third and fourth ventricles and total ventricular volumes. ICV = intracranial volume.

Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017 45 Junior MLMS et al.

ACKNOWLEDGMENTS JH-XO  3XE0HG30Ζ'  /RQJ;/LDR:-LDQJ&/LDQJ'4LX%=KDQJ/+HDOWK\DJLQJDQDXWRPDWLF :HWKDQNWR)$&(3(±)XQGDomRGH$PSDURj analysis of global and regional morphological alterations of . &LrQFLDH7HFQRORJLDGR(VWDGRGH3HUQDPEXFR $FDGHPLFUDGLRORJ\-XO  3XE0HG30Ζ'  0DWVXPDH0.LNLQLV50RURF]Ζ$/RUHQ]R$96DQGRU7$OEHUW06HWDO Age-related changes in intracranial compartment volumes in normal adults REFERENCES DVVHVVHGE\PDJQHWLFUHVRQDQFHLPDJLQJ-RXUQDORIQHXURVXUJHU\ -XQ  3XE0HG30Ζ'  )HUUDULQL / 3DOP :0 2ORIVHQ + YDQ %XFKHP 0$ 5HLEHU -+ $GPLUDDO-  1HVWRU 60 5XSVLQJK 5 %RUULH 0 6PLWK 0 $FFRPD]]L 9 :HOOV -/ HW DO %HKORXO)6KDSHGL΍HUHQFHVRIWKHEUDLQYHQWULFOHVLQ$O]KHLPHUȇVGLVHDVH 9HQWULFXODUHQODUJHPHQWDVDSRVVLEOHPHDVXUHRI$O]KHLPHUȇVGLVHDVHSUR- 1HXURΖPDJH6HS  3XE0HG30Ζ' JUHVVLRQ YDOLGDWHG XVLQJ WKH $O]KHLPHUȇV GLVHDVH QHXURLPDJLQJ LQLWLDWLYH  %ODWWHU''%LJOHU('*DOH6'-RKQVRQ6&$QGHUVRQ&9%XUQHWW%0HW GDWDEDVH%UDLQDMRXUQDORIQHXURORJ\6HS 3W 3XE- DO 4XDQWLWDWLYH YROXPHWULF DQDO\VLV RI EUDLQ 05 QRUPDWLYH GDWDEDVH 0HG30Ζ'3XEPHG&HQWUDO30&Ζ' VSDQQLQJGHFDGHVRIOLIH$-15$PHULFDQMRXUQDORIQHXURUDGLRORJ\  %ULFNPDQ $0 6FKXSI 1 0DQO\ -- /XFKVLQJHU -$ $QGUHZV + 7DQJ 0; )HE  3XE0HG30Ζ' HW DO %UDLQ PRUSKRORJ\ LQ ROGHU $IULFDQ $PHULFDQV &DULEEHDQ +LVSDQL-  &R΍H\&(:LONLQVRQ:(3DUDVKRVΖ$6RDG\6$6XOOLYDQ5-3DWWHUVRQ/-HW FV DQG ZKLWHV IURP QRUWKHUQ 0DQKDWWDQ $UFKLYHV RI QHXURORJ\  DO4XDQWLWDWLYHFHUHEUDODQDWRP\RIWKHDJLQJKXPDQEUDLQDFURVVVHFWLR- $XJ   3XE0HG 30Ζ'  3XEPHG &HQWUDO 30&Ζ' QDOVWXG\XVLQJPDJQHWLFUHVRQDQFHLPDJLQJ1HXURORJ\0DU 3W   3XE0HG30Ζ'  .UHPHQ :6 3DQL]]RQ 06 1HDOH 0& )HQQHPD1RWHVWLQH & 3URP:RU-  )MHOO$0:DOKRYG.%)HQQHPD1RWHVWLQH&0F(YR\/.+DJOHU'-+ROODQG POH\((\OHU/7HWDO+HULWDELOLW\RIEUDLQYHQWULFOHYROXPHFRQYHUJLQJHYL- D, et al. One-year brain atrophy evident in healthy aging. The Journal of GHQFHIURPLQFRQVLVWHQWUHVXOWV1HXURELRORJ\RIDJLQJ-DQ   QHXURVFLHQFH  WKH RɝFLDO MRXUQDO RI WKH 6RFLHW\ IRU 1HXURVFLHQFH  3XE0HG30Ζ'3XEPHG&HQWUDO30&Ζ' 'HF    3XE0HG 30Ζ'  3XEPHG &HQWUDO 30-  :DOKRYG.%:HVWO\H/7$POLHQΖ(VSHVHWK75HLQYDQJΖ5D]1HWDO&RQ- &Ζ' VLVWHQW QHXURDQDWRPLFDO DJHUHODWHG YROXPH GL΍HUHQFHV DFURVV PXOWLSOH  *XLPDUDHV 50 6FKDXIHOEHUJHU 06 6DQWRV /& 'XUDQ )/ 0HQH]HV 35 VDPSOHV 1HXURELRORJ\ RI DJLQJ  0D\   3XE0HG 30Ζ' 6FD]XIFD0HWDO/RQJLWXGLQDOEUDLQYROXPHWULFFKDQJHVGXULQJRQH\HDU 3XEPHG&HQWUDO30&Ζ' LQQRQHOGHUO\KHDOWK\DGXOWVDYR[HOEDVHGPRUSKRPHWU\VWXG\%UD]LOLDQ  6XOOLYDQ(95RVHQEORRP06HUYHQWL./3IH΍HUEDXP$(΍HFWVRIDJHDQG MRXUQDORIPHGLFDODQGELRORJLFDOUHVHDUFK 5HYLVWDEUDVLOHLUDGHSHVTXL- sex on volumes of the , pons, and cortex. Neurobiology of aging. VDVPHGLFDVHELRORJLFDV-XQ  3XE0HG30Ζ' )HE  3XE0HG30Ζ' 3XEPHG&HQWUDO30&Ζ'  6]DER&$/DQFDVWHU-/;LRQJ-&RRN&)R[305LPDJLQJYROXPHWU\RI  5HVQLFN603KDP'/.UDXW0$=RQGHUPDQ$%'DYDW]LNRV&/RQJLWXGL- subcortical structures and cerebellar hemispheres in normal persons. QDOPDJQHWLFUHVRQDQFHLPDJLQJVWXGLHVRIROGHUDGXOWVDVKULQNLQJEUDLQ $-15$PHULFDQMRXUQDORIQHXURUDGLRORJ\$SU  3XE0HG 7KH-RXUQDORIQHXURVFLHQFHWKHRɝFLDOMRXUQDORIWKH6RFLHW\IRU1HXURV- 30Ζ' FLHQFH$SU  3XE0HG30Ζ'  *XU5&0R]OH\3'5HVQLFN60*RWWOLHE*/.RKQ0=LPPHUPDQ5HWDO  $PEDUNL . ΖVUDHOVVRQ + :DKOLQ $ %LUJDQGHU 5 (NOXQG $ 0DOP - %UDLQ *HQGHU GL΍HUHQFHV LQ DJH H΍HFW RQ EUDLQ DWURSK\ PHDVXUHG E\ PDJQH- ventricular size in healthy elderly: comparison between Evans index and WLFUHVRQDQFHLPDJLQJ3URFHHGLQJVRIWKH1DWLRQDO$FDGHP\RI6FLHQFHV YROXPH PHDVXUHPHQW 1HXURVXUJHU\  -XO   GLVFXVVLRQ  RIWKH8QLWHG6WDWHVRI$PHULFD$SU  3XE0HG30Ζ' 3XE0HG30Ζ' 3XEPHG&HQWUDO30&Ζ'  &KXQJ6&7DFN*5

46 Revista Brasileira de Neurologia » Volume 53 » Nº 3 » Jul/Ago/Set 2017