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A Morphometric Study of Ventricular System of Human Brain by Computerised Tomography in an Indian Population and its Clinical Significance

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A Morphometric Study of Ventricular System of Human Brain by Computerised Tomography in an Indian Population and its Clinical Significance

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Background and Aim: The human brain undergoes many gross and histopathological changes with regression of the brain tissue leading to the enlargement of the ventricles as age advances. Knowledge of morphometric and size of normal ventricular system of brain is of paramount importance to understand these changes.
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Citation: Honnegowda TM, Nautiyal A and Deepanjan M. A Morphometric Study of Ventricular System of Human
Brain by Computerised Tomography in an Indian Population and its Clinical Signicance. Austin J Anat. 2017;
4(4): 1075.
Austin J Anat - Volume 4 Issue 4 - 2017
ISSN : 2381-8921 | www.austinpublishinggroup.com
Honnegowda et al. © All rights are reserved
Austin Journal of Anatomy
Open Access
Abstract
Background and Aim: The human brain undergoes many gross and
histopathological changes with regression of the brain tissue leading to the
enlargement of the ventricles as age advances. Knowledge of morphometric
and size of normal ventricular system of brain is of paramount importance to
understand these changes.
Methods: For the present perspective study, Computerized Tomography
(CT) for 250 patients (Males-130 and Females-120) were studied for the
measurements of lateral ventricle, third ventricle and fourth ventricle and it was
statistically analyzed.
Results: The antero -posterior extent of the body of the lateral ventricles on
the right side was 77.45 ± 8.6 and 71.36 ± 9.4 in the males and females and on
the left side was 76.6 ± 8.4 and 71.09 ± 9.4mm in the males and females; the
length of the frontal horns on the right side was 30.54 ± 3.4 and 28.4 ± 4.2mm in
the males and females and on the left side was 30.14 ± 4.7 and 27.4 ± 3.2 mm in
the males and females respectively. The width and height of the fourth ventricle
were 13.0 ± 1.9 and 10.0 ± 2.1 mm in the males and 12.0 ± 2.0 mm and 9.6 ±
2.2 mm in the females respectively. The width of the third ventricle was 5.9 ± 1.5
and 5.5 ± 1.9 mm in the males and females respectively.
Conclusion: The present study has dened the morphometric
measurements of the lateral ventricles, third ventricle, and fourth ventricle of the
brain which has clinical correlations in diagnosis and for appropriate treatment.
Keywords: Brain; Morphometry; Ventricular System; Size; Subjects;
Tomography
measurement of cerebral ventricular system in india the present work
is undertaken to study morphometric analysis of the lateral, third
and fourth ventricles of the brain in normal Indian subjects using CT
scan.
Materials and Methods
Selection and study Population
is prospective study population composed of 250 patients (130
males and 120 females) in the age group of 12 to 81 years, attending
the department for Brain PET/CT procedure at Institute of Nuclear
Medicine & Molecular Imaging, AMRI Hospital, Kolkata.
ese patients were selected randomly and clinically conrmed
no history of cerebral infarction, local mass lesions, probable
communicating hydrocephalus, alcoholism, drug abuse, trauma
or previous intra-cranial surgery and other hereditary diseases and
were not on medication at the time of this study. All patients were
in fasting condition (minimum 6 hrs) before undergone for the CT
procedure. PET /CT scan of all patients were reported by expert
nuclear Medicine physician scoring as normal.
Procedure of CT scanning technique
e CT scanner used in this study was the General electric GE
Introduction
e cavity with in the brain is ventricles lled with Cerebrospinal
Fluid (CSF). e lateral ventricles are the largest paired ventricles
present within the cerebrum; the third ventricle is in the diencephalon
of the forebrain between the thalami; and the fourth ventricle is
located posterior to the Pons and open part of the medulla oblongata
of the hindbrain [1].
Objective and morphometric studies of human brain ventricles is
under limelight, recently due to it is relation with several pathologies
evidences such as schizophrenia, hydrocephalus, tumors, Trauma
and as well as gender and aging which could lead to dementia [2]. By
CT scanning ventricles of the brain can be studied and well visualized,
and their overall conguration can be reconstructed from a series
of contiguous slices [3]. Knowing the normal measurements of the
cerebral ventricles in the living human has great importance in the
diagnosis and monitoring of several pathologies [4]. It should be noted
that there is a continuous debate in the literature of neuroanatomy,
psychiatry, neuroradiology and neurology over the best method of
assessing the various parts of the cerebral ventricular system and
the information known regarding the accurate measurements of the
brain ventricles is limited [5]. Since very few work has been done on
Research Article
A Morphometric Study of Ventricular System of Human
Brain by Computerised Tomography in an Indian
Population and its Clinical Signicance
Honnegowda TM1*, Nautiyal A2 and Deepanjan M2
1Human Anatomy, Department of Plastic Surgery and
Burns, Kasturba Medical College, Manipal, Manipal
University, India
2Nuclear Medicine Physicist, Institute of Nuclear
Medicine and Molecular Imaging, AMRI Hospitals, India
*Corresponding author: Honnegowda TM, Human
Anatomy, Department of Plastic Surgery and Burns,
Kasturba Medical College, Manipal, Manipal University,
Manipal, India
Received: September 30, 2017; Accepted: December
15, 2017; Published: December 22, 2017
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discovery 690 PET/CT (64 slices). e selected exposure factors for
the CT scan were 80-120 kvp and 250-450 mAs, the slice thickness
was 3 mm and the noise index was 3. All CT Scans was performed in
axial mode with iterative reconstruction algorithm.
e patient was placed on the PET/CT table and the head was
centralized and supported for correct positioning and to avoid
blurring of images. A lateral scout image was taken to conrm correct
positioning of patient. Orbito-meatal line was drawn and a line at an
angle of 15 - 20 degrees to and 1 cm above it was drawn, representing
the lowest tomographic section, which passed through the base of
skull. Total time of CT scan was 20-30 second followed by PET. A
total of 8 to 10 sections were obtained without any overlap [6,7]. All
processing and measurement of axial CT images were performed in
ADW work station.
Method of measuring the brain ventricle
e measurements were taken as follows:
1) Lateral Ventricle Measurement
a) Length of right lateral ventricular body inclusive of level of
interventricular foramen. Frontal horn (taken from tip of frontal
horn to the atrium).
b) Length of le lateral ventricular body inclusive of frontal horn
(taken from tip of frontal horn to the atrium) can be seen in (Figure
1).
2) Level of Interventricular Foramen
a) Length of frontal horns of right lateral ventricle in Foramen
(measured from its tip to the interventricular foramen).
b) Length of frontal horns of le lateral ventricle in cm (measured
from its tip to the interventricular foramen) can be seen in (Figure 2).
3) Level of ird Ventricle
Figure 1: CT axial image of the brain showing the length of right and left
ventricles. The gray lines indicate the height and the width.
Figure 2: CT axial image of the brain showing the length of body of the
lateral ventricles. The gray lines indicate the length of the body of both lateral
ventricles.
Figure 3: CT axial image of the brain showing the length of the left lateral
ventricle and body of right ventricle. The three lines show the length of body of
right ventricle, length of the whole left ventricle and width of the third ventricle
respectively.
Figure 4: CT axial image of the brain showing the width and height
measurement of the 4th ventricle. The gray lines indicate the height and the
width.
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a) Greatest width of third ventricle in mm can be seen in (Figure
3).
4) Level of Fourth Ventricle
a) Greatest height of fourth ventricle in mm (Figure 4).
b) Greatest width of fourth ventricle in mm (Figure 4).
Statistical analysis
Data were analyzed and expressed in mean ± SD. paired t test was
performed between male and female group for a set of parameters,
using the SPSS 16th version. e p-value is less than 0.05 were
considered to be signicant.
Results
It was observed that the anteroposterior extent of the body of
the right and le ventricles was equal in the female 71.36 ± 9.4 mm
whereas, it was larger in the right side 77.45 ± 8.6 mm than the le
side 76.6 ± 8.4 mm in the males. e length of the frontal horns on
the right side was 29.53 + 3.88 mm and 27.16 + 4.21 mm in the males
and females and on the le side were 30.54 ± 3.4 mm and 28.4 ± 4.2
mm in the males and females (Table 2). e mean height and width
of the fourth ventricle were 10.0 ± 2.1 and 13.0 ± 1.9mm in the males
and 9.6 ± 2.2 mm and 12.0 ± 2.0mm in the females respectively as
shown in (Table 1). On correlation between width of third and fourth
ventricle with age showed positive correlation which was statistically
signicant as shown in (Table 3). e measurement of the ventricles
was obtained from the CT monitor using the curser were shown in
(Figures 1-4).
Discussion
e ventricular size of the brain is likely to be an increased in
number of circumstances of several neurological disorders such as
hydrocephalus, cerebral atrophy, Alzheimer’s disease, Parkinson’s
disease, in which precise measurements will be of value [8].
Morphometric study of cerebral ventricles provides useful indices of
cerebral asymmetry and atrophy [9]. A study by Matsuzua, Goldestien
et al. shown that the le lateral ventricle was larger than the right one
and both were larger in the female [10]. In the present study antero-
posterior extent of the body of the right lateral ventricle 77.89 ± 9.86
mm and 71.06 ± 8.83 mm males and females, on the le side was
75.89 ± 8.56 mm and 69.56 ± 10.00 mm.
Both le and right ventricles were large in males compared to
females. is is because males skull were heavier and bigger, the
capacity of the skull is more compared to female skull and also
because the brain size is more in males compared to females [11].
Our study results revealed that the length of the right frontal
horns was 30.54 ± 3.4 mm in the males and 28.4 ± 4.2mm in the
females and that the length of the le frontal horns was equal to the
right one in the males but slightly shorter than the right one in the
females 27.4 ± 3.2 mm. Studies by D’Souza and Natekar revealed that
the height of the fourth ventricle was 11.8 mm and 11.1 mm for the
male and female respectively [12]. Older studies by Gawler et al. [13]
revealed that the greatest distance between the roof and the oor of
the fourth ventricle was less than 10.8 mm [14]; however in our study
this distance was signicantly smaller, (9.66 ± 0.22 mm) in males and
(9.70 ± 0.28 mm) in the females with the mean 9.68 ± 0.17 mm).
In the present study, the width of the fourth ventricle was found
to be greater than the height in both genders and was more in males
(13.0 ± 1.9) than in females 12.0 ± 2.0 ) with the mean 12.4 ± 1.08
mm. Gawlar J et al. and others measured the width of third ventricle
[13,14]. Soininen et al. [14], D’Souza et al, [12], Meshram, P et al
[15], Brinkman et al. [16] found that the maximum mean width of
the third ventricle was 5.9 mm, 9.2 mm, 4.2 mm. In present study,
we found this measure was signicantly higher in males (5.9 mm) as
compared to females (5.5 mm) with mean (5.8 mm). On performing
paired‘t’ test to all the parameters between male and female the p value
is signicant (P<0.05) except height of fourth ventricle (p = 0.556).
Conclusion
e study provided useful morphometric data to better
Parameters Sample size (n) Mean ± SD
(Max- Min in mm)
Length of body of the right ventricle 250 76.23 ± 9.4
(105-40)
Length of body of the left ventricle 250 72.43 ± 8.78
(106-20 mm)
Length of right frontal horn of Lateral
ventricle 250 29.2 ± 3.72
(37-15mm)
Length of left frontal horn of lateral
ventricle 250 28.7 ± 2.9
(37-16 mm)
Width of the third ventricle 250 5.8 ± 2.10
(11-3 mm)
Height of the fourth ventricle 250 9.9 ± 1.5
(19-4 mm)
Width of the fourth ventricle 250 12.4 ± 1.08
(13.5- 8 mm)
Table 1: List of measurements and statistical details of lateral, third and fourth
ventricles.
Parameters Mean ± SD (Max- Min) P- value
Males
(n=130) Females
(n=120)
Length of body of the right ventricle 77.45±8.6 71.36±9.4 0.004
Length of body of the left ventricle 76.6±8.4 71.09±9.4 0.022
Length of right frontal horn of Lateral
ventricle 30.54±3.4 28.4±4.2 0.034
Length of left frontal horn of lateral
ventricle 30.14±4.7 27.4±3.2 0.002
Width of the third ventricle 5.9±1.5 5.5±1.9 0.011
Height of the fourth ventricle 10.0±2.1 9.6±2.2 0.556
Width of the fourth ventricle 13.0±1.9 12.0±2.0 0.007
Table 2: List of ventricular measurements (mean ± SD) in males and females.
Pearson Correlation
coefcient P value
Width of 4th ventricle and age 0.235 0.045
width of the third ventricle and
age 0.392 0.039
Table 3: Correlation study between age and width of the 4th and 3rd ventricles.
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understand the lateral, third and fourth ventricles while diagnosing
clinical problems associated with the various types of ventricular
enlargement such as hydrocephalus, schizophrenia, psychotic
disorders, Parkinsonism and other pathologic disorders.
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Citation: Honnegowda TM, Nautiyal A and Deepanjan M. A Morphometric Study of Ventricular System of Human
Brain by Computerised Tomography in an Indian Population and its Clinical Signicance. Austin J Anat. 2017;
4(4): 1075.
Austin J Anat - Volume 4 Issue 4 - 2017
ISSN : 2381-8921 | www.austinpublishinggroup.com
Honnegowda et al. © All rights are reserved
... The ventricular size of the brain likely increased in a number of circumstances of several neurological disorders such as hydrocephalus, cerebral atrophy, Alzheimer's disease, Parkinson's disease. Measurements of the size of the frontal horns of lateral ventricle provide useful indicators of cerebral asymmetry and brain atrophy [7]. To the best of our knowledge, this is the first reported study in Ethiopia. ...
... This finding was consistent with a study done in Meerut on western Uttar Pradesh population [1]. However, it is inconsistent with the observations made in India that the left frontal horn length was equal to the right one in the males but slightly shorter than the right one in the female [7]. This might be due to the differences in the age group that was larger in India, which were between 12 and 80 years. ...
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... KanakarajKetal [29] also have shown significant differences between male and female in relation to the third ventricle measurement but no significant differences noted for the fourth ventricle. The fourth ventricle width was found to be 13.0 mm and 12.0 mm in males and females, respectively [32]. The corresponding values of both Saudi Arabian males and females were; 12.54 mm and 11.60 mm with significant statistical difference (p=0.005) . ...
... [9] This value was higher in males than females and the highest the fourth ventricle values were in age group of 70 years in both genders. [9,32] In the present study the greatest AP-Length in males (10.92 ± 1.51 mm) was more than in females (10.48 ± 1.76 mm). The width of the fourth ventricle was found to be greater than the AP length in both gender and was more in males (12.32 ± 1.48 mm) than in females (11.85 ± 1.32 mm). ...
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... KanakarajKetal [29] also have shown significant differences between male and female in relation to the third ventricle measurement but no significant differences noted for the fourth ventricle. The fourth ventricle width was found to be 13.0 mm and 12.0 mm in males and females, respectively [32]. The corresponding values of both Saudi Arabian males and females were; 12.54 mm and 11.60 mm with significant statistical difference (p=0.005) . ...
... [9] This value was higher in males than females and the highest the fourth ventricle values were in age group of 70 years in both genders. [9,32] In the present study the greatest AP-Length in males (10.92 ± 1.51 mm) was more than in females (10.48 ± 1.76 mm). The width of the fourth ventricle was found to be greater than the AP length in both gender and was more in males (12.32 ± 1.48 mm) than in females (11.85 ± 1.32 mm). ...
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CT was used to document temporal lobe atrophy in 39 patients who were diagnosed clinically as having Alzheimer disease; the results were compared with those from 29 healthy elderly control subjects who were matched for age and education. The diagnosis of Alzheimer disease was made according to clinical criteria consistent with those specified by an NINCDS workshop. These included detailed medical and neuropsychological assessments. Temporal lobe atrophy was assessed by evaluating the temporal horns and sylvian cisterns. Temporal horn measurements greater than 3 mm occurred only in patients with Alzheimer disease while measurements less than or equal to this occurred in both Alzheimer patients and control subjects. Subjective evaluation of the sylvian cistern indicated that 24/29 controls had normal-appearing cisterns while only 5/39 Alzheimer patients had similar findings. In contrast to temporal horns, sylvian cisterns were more sensitive but less specific as discriminators between Alzheimer patients and normal controls.
Article
Using computed tomography, the authors studied enlargement of the ventricles and the free spaces (cisternae and sulci) above the level of the tentorium cerebelli during aging in 97 men and 55 women with no neurologic disturbances, ranging in age from 17 to 86 years, and calculated a ventricular volume index (100% X ventricular volume/cranial cavity volume) and a free space volume index (100% X free space volume/cranial cavity volume). Both the ventricular volume and the ventricular volume index started to increase significantly in the forties in men and in the fifties in women. Both the free space volume and the free space volume index were found not to increase until the sixties in both men and women. Both the ventricular volume index and the free space volume index were smaller in hypertensives than in normotensives in men over age 65.
Article
Computed tomography (CT) findings in 57 patients with senile dementia of Alzheimer type (SDAT), 19 patients with multi-infarct dementia and 85 controls of similar age and sex were studied. The SDAT patients differed from the controls of ventricular dilatation, frontal horn index, cella media index and the width of the third ventricle, and also in the index of cortical atrophy. Even the least severely demented SDAT patients differed from the controls. In the SDAT group with the increasing degree of intellectual impairment the ventricular dilatation increased, but cortical atrophy did not correlate with the psychological test score. The multi-infarct dementia patients differed from the controls in all CT variables including local changes. The SDAT patients had a more marked ventricular dilatation than the multi-infarct dementia patients. The multi-infarct dementia patients had more frequently local changes in SDAT patients. In the control group age correlated with ventricular dilatation, and the lower test scores correlated with cortical atrophy in the left temporal region.
Article
Quantitative indexes of compute tomography were compared in 28 patients with Alzheimer dementia and in 30 elderly persons with no history of neurologic disease. Age-corrected ventricle-brain ratios were abnormal for half of the dementia patients, whereas only a single subject in the control group had ventricles outside the limits of normal variation. Measurement of the distance between the third ventricle and Sylvian fissure indicated that the dementia patients had significantly more atrophy in this area. Employment of quantitative indexes standardized for age may aid in differentiating cerebral atrophy associated with dementia from that associated with normal aging.