scholarly journals Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
David Fällmar ◽  
Oliver Andersson ◽  
Lena Kilander ◽  
Malin Löwenmark ◽  
Dag Nyholm ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Diagnostic Accuracy ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Differential Diagnoses ◽  
Imaging Features ◽  
Atypical Parkinsonism ◽  
Healthy Controls ◽  
Evans Index ◽  
Imaging Markers

Abstract Background Vascular dementia (VaD) and atypical parkinsonism often present with symptoms that can resemble idiopathic normal pressure hydrocephalus (iNPH) and enlarged cerebral ventricles, and can be challenging differential diagnoses. The aim was to investigate frequencies of imaging features usually associated with iNPH and their radiological diagnostic accuracy in a sample containing the relevant differential diagnoses VaD, progressive supranuclear palsy (PSP), multiple system atrophy parkinsonian type (MSA-P), and healthy controls. Methods Nine morphological imaging features usually associated with iNPH were retrospectively investigated in MR images of 55 patients with shunt-responsive iNPH, 32 patients with VaD, 30 patients with PSP, 27 patients with MSA-P, and 39 age-matched healthy controls. Logistic regression and receiver operating characteristic curves were used to assess diagnostic accuracy, sensitivity, and specificity for each imaging finding. Results In a logistic regression model using iNPH diagnosis as a dependent variable, the following imaging features contributed significantly to the model: callosal angle (OR = 0.95 (0.92–0.99), p = 0.012), Evans’ index * 100 (OR = 1.51 (1.23–1.86), p < 0.001), enlarged Sylvian fissures (OR = 6.01 (1.42–25.40), p = 0.015), and focally enlarged sulci (OR = 10.18 (1.89–55.02), p = 0.007). Imaging features with 95% specificity for iNPH were: callosal angle ≤ 71°, temporal horns ≥ 7 mm, Evans’ index ≥ 0.37, iNPH Radscale ≥ 9, and presence of DESH, bilateral ventricular roof bulgings or focally enlarged sulci. A simplified version of the iNPH Radscale with only four features resulted in equally high diagnostic accuracy as the original iNPH Radscale. Conclusions There is a notable overlap between some of the commonly used imaging markers regarding iNPH, VaD and atypical parkinsonism, such as PSP. However, this study shows that the specificity of imaging markers usually associated with iNPH was high even when comparing with these challenging differential diagnoses. The callosal angle was the single imaging feature with highest diagnostic accuracy to discriminate iNPH from its mimics. A simplified rating scale using only a few selected features could be used with retained specificity.

Idiopathic Normal-Pressure Hydrocephalus: Diagnostic Accuracy of Automated Sulcal Morphometry in Patients With Ventriculomegaly

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E747-E755 ◽  
Author(s):  
Grégory Kuchcinski ◽  
Caroline Jacquiez ◽  
Marc Baroncini ◽  
François Machuron ◽  
Hélène Béhal ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Normal Pressure Hydrocephalus ◽  
Therapeutic Option ◽  
Brain Magnetic Resonance Imaging ◽  
Normal Pressure ◽  
Cognitive Disorder ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Healthy Controls ◽  
Best Parameter ◽  
Vascular Cognitive Disorder

Abstract BACKGROUND Idiopathic normal-pressure hydrocephalus (iNPH) is a treatable cause of gait and cognitive impairment. iNPH should be differentiated from ventriculomegaly secondary to brain atrophy to choose the best therapeutic option (ventriculoperitoneal shunt vs medical management). OBJECTIVE To determine the diagnostic accuracy of automated sulcal morphometry to differentiate patients with iNPH from patients with ventriculomegaly of neurodegenerative origin. METHODS Thirty-eight consecutive patients with iNPH (shunt responsive n = 31, nonresponsive n = 7), 35 with vascular cognitive disorder, and 25 age- and sex-matched healthy controls were prospectively included and underwent cognitive evaluation and 3T brain magnetic resonance imaging. Sulcal opening of 10 sulci of interest was retrospectively measured using an automated surface-based approach from the 3-dimensional T1-weighted images. Receiver-operating characteristic curve analyses determined the best parameter to identify iNPH patients. RESULTS The best parameter to discriminate shunt-responsive iNPH from patients with vascular cognitive disorder and healthy controls was the ratio between calcarine sulcus and cingulate sulcus opening with an area under the curve of 0.94 (95% CI: 0.89, 0.99). A cut-off value of 0.95 provided the highest sensitivity (96.8%) and specificity (83.3%). CONCLUSION This preliminary study showed that automated sulcal morphometry may help the neurosurgeon to identify iNPH patients and to exclude other causes of ventriculomegaly.

scholarly journals Cerebral Ventriculomegaly in Myotonic Dystrophy Type 1: Normal Pressure Hydrocephalus-like Appearances on Magnetic Resonance Imaging

2021 ◽  
Author(s):  
Saya Iida ◽  
Hiroko Seino ◽  
Fumiko Nagahata ◽  
Soichiro Tatsuo ◽  
Sho Maruyama ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Normal Pressure Hydrocephalus ◽  
Axial Length ◽  
Normal Pressure ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Imaging Characteristics ◽  
Evans Index ◽  
Ctg Repeat

Abstract Background: Cerebral ventriculomegaly is an abnormal feature characteristic of myotonic dystrophy type 1 (DM1). This retrospective study investigated the morphologic changes accompanied by ventriculomegaly in DM1 on brain MRI.Methods: One hundred and twelve adult patients with DM1 and 50 sex- and age-matched controls were assessed. The imaging characteristics for evaluations included the z-Evans Index (ventriculomegaly), callosal angle (CA), enlarged perivascular spaces in the centrum semiovale (CS-EPVS), temporo-polar white matter lesion (WML) on 3D fluid-attenuated inversion recovery (FLAIR), disproportionately enlarged subarachnoid-space hydrocephalus (DESH), and pathological brain atrophy. The “z-Evans Index” was defined as the maximum z-axial length of the frontal horns to the maximum cranial z-axial length. To determine the imaging characteristics and genetic information (CTG repeat numbers) that were associated with the z-Evans Index, we used multivariate logistic regression analyses.Results: The z-Evans Index was significantly larger in the patients than in the controls (0.30±0.05 vs. 0.24 ± 0.02; p < 0.01). The multivariate logistic regression analyses showed that the z-Evans Index was independently associated with the patient age (p <0.05), CA (p < 0.01), Sylvian fissure dilation (p < 0.01), and pathological brain atrophy (p < 0.01) but not with CTG repeat numbers, CS-EPVS, or temporo-polar WML. Of the 34 patients older than 49 years, 7 (20.6%) were considered to have DESH.Conclusions: Our MRI study revealed a normal pressure hydrocephalus (NPH)-like appearance as a morphologic finding accompanied by ventriculomegaly in DM1 that tends to occur in elderly patients.

scholarly journals Neuroimaging in normal pressure hydrocephalus

2015 ◽  
Vol 9 (4) ◽  
pp. 350-355 ◽  
Author(s):  
Benito Pereira Damasceno
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Cerebral Atrophy ◽  
High Sensitivity ◽  
Normal Pressure ◽  
Evans Index ◽  
Flow Void ◽  
High Positive Predictive Value ◽  
Subarachnoid Spaces ◽  
Magnetic Resonance Imaging Mri ◽  
Improved Accuracy

ABSTRACT Normal pressure hydrocephalus (NPH) is a syndrome characterized by the triad of gait disturbance, mental deterioration and urinary incontinence, associated with ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. The clinical presentation (triad) may be atypical or incomplete, or mimicked by other diseases, hence the need for supplementary tests, particularly to predict postsurgical outcome, such as CSF tap-tests and computed tomography (CT) or magnetic resonance imaging (MRI). The CSF tap-test, especially the 3 to 5 days continuous external lumbar drainage of at least 150 ml/day, is the only procedure that simulates the effect of definitive shunt surgery, with high sensitivity (50-100%) and high positive predictive value (80-100%). According to international guidelines, the following are CT or MRI signs decisive for NPH diagnosis and selection of shunt-responsive patients: ventricular enlargement disproportionate to cerebral atrophy (Evans index >0.3), and associated ballooning of frontal horns; periventricular hyperintensities; corpus callosum thinning and elevation, with callosal angle between 40º and 90º; widening of temporal horns not fully explained by hippocampal atrophy; and aqueductal or fourth ventricular flow void; enlarged Sylvian fissures and basal cistern, and narrowing of sulci and subarachnoid spaces over the high convexity and midline surface of the brain. On the other hand, other imaging methods such as radionuclide cisternography, SPECT, PET, and also DTI or resting-state functional MRI, although suitable for NPH diagnosis, do not yet provide improved accuracy for identifying shunt-responsive cases.

Normal Pressure Hydrocephalus as a Possible Reversible Cause of Dementia, Neuroimaging Findings

2017 ◽  
Vol 41 (S1) ◽  
pp. S629-S630 ◽  
Author(s):  
A. Zacharzewska-Gondek ◽  
T. Gondek ◽  
M. Sąsiadek ◽  
J. Bladowska
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Brain Atrophy ◽  
Correct Diagnosis ◽  
Normal Pressure ◽  
Third Ventriculostomy ◽  
Imaging Features ◽  
Central Brain ◽  
Flow Void ◽  
Competing Interest ◽  
Magnetic Resonance Imaging Mri

IntroductionNormal pressure hydrocephalus (NPH) occurs in 0.5% of persons over 65 years old. The etiology of NPH is still unknown. Clinically NPH is characterised by cognitive deterioration, gait impairment and urinary incontinence. NPH is a possible reversible cause of dementia. Neuroimaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) allow to assess typical brain changes in this disorder.The objectives are to present the typical findings of NPH on CT and MRI and to demonstrate differences between NPH and central brain atrophy in neuroimaging.ResultsThe imaging features of NPH include: supratentorial ventriculomegaly with callosal angle less than 90o, tight sulci at the vertex and considerable out of proportion enlargement of Sylvian fissures. In case of central brain atrophy there may be a predominance of ventriculomegaly and/or widened sulci without crowding of the gyri at the vertex and callosal angle greater than 90o. In both entities, the decrease of density in periventricular region may be seen: in NPH could be a sign of transependymal oedema or in brain atrophy as an accompanying leukoaraiosis. Additionally, it is possible to assess changes in flow of cerebrospinal fluid (CSF) on MRI: in NPH an increased pulsatile CSF circulation in aqueduct as flow void sign may be observed.ConclusionsCorrect diagnosis of NPH on CT or MRI in relation to clinical data is very important. Treatment with ventriculoperitoneal shunt or third ventriculostomy may partially improve the quality of life in some patients with cognitive impairment due to NPH.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review

2022 ◽  
Vol 13 ◽  
Author(s):  
Xi Zhou ◽  
Jun Xia
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Clinical Symptoms ◽  
Normal Pressure ◽  
Clinical Value ◽  
Incontinence Surgery ◽  
Special Software ◽  
Evans Index ◽  
Ventricle Volume ◽  
Threshold Setting ◽  
Urinary Incontinence Surgery

With an ever-growing aging population, the prevalence of normal pressure hydrocephalus (NPH) is increasing. Clinical symptoms of NPH include cognitive impairment, gait disturbance, and urinary incontinence. Surgery can improve symptoms, which leads to the disease's alternative name: treatable dementia. The Evans index (EI), defined as the ratio of the maximal width of the frontal horns to the maximum inner skull diameter, is the most commonly used index to indirectly assess the condition of the ventricles in NPH patients. EI measurement is simple, fast, and does not require any special software; in clinical practice, an EI &gt;0.3 is the criterion for ventricular enlargement. However, EI's measurement methods, threshold setting, correlation with ventricle volume, and even its clinical value has been questioned. Based on the EI, the z-EI and anteroposterior diameter of the lateral ventricle index were derived and are discussed in this review.

Amyloid Deposits and Idiopathic Normal-Pressure Hydrocephalus: An 18F-Florbetaben Study

2018 ◽  
Vol 79 (3-4) ◽  
pp. 192-199 ◽  
Author(s):  
Kyunghun Kang ◽  
Uicheul Yoon ◽  
Jinwoo Hong ◽  
Shin Young Jeong ◽  
Pan-Woo Ko ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Rating Scale ◽  
Clinical Symptoms ◽  
Neuronal Degeneration ◽  
Normal Pressure ◽  
Hippocampal Volume ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Healthy Controls ◽  
Clinical Dementia Rating ◽  
Imaging Results

Background: The first aim of our study was to determine whether cortical 18F-florbetaben retention was different between healthy controls and idiopathic normal-pressure hydrocephalus (INPH) patients. Our second aim was to investigate whether there were any relationships between 18F-florbetaben retention and either hippocampal volume or clinical symptoms in INPH patients. Methods: Seventeen patients diagnosed with INPH and 8 healthy controls underwent studies with magnetic resonance imaging and 18F-florbetaben positron emission tomography imaging. Results: Automated region-of-interest analysis showed significant increases in 18F-florbetaben uptake in several brain regions in INPH patients compared to control subjects, with especially remarkable increases in the frontal (bilateral), parietal (bilateral), and occipital (bilateral) cortices. In the INPH group, right hippocampal volume was found to be negatively correlated with right frontal 18F-florbetaben retention. Korean-Mini Mental State Examination scores negatively correlated with right occipital 18F-florbetaben retention. Higher 18F-florbetaben retention correlated significantly with a higher Clinical Dementia Rating Scale score in the right occipital cortex. Conclusions: Our results indicate that INPH might be a disease exhibiting a characteristic pattern of cortical 18F-florbetaben retention. 18F-florbetaben retention in the frontal cortex may be related to hippocampal neuronal degeneration. Our findings may also help us understand the potential pathophysiology of cognitive impairments associated with INPH.

scholarly journals Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Hajime Yokota ◽  
Arvind Vijayasarathi ◽  
Milos Cekic ◽  
Yoko Hirata ◽  
Michael Linetsky ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Normal Pressure Hydrocephalus ◽  
Diagnostic Performance ◽  
Roc Analysis ◽  
Diffusion Tensor ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Glymphatic System ◽  
Evans Index ◽  
Diffusion Tensor Imaging Dti

Purpose. To investigate the pathological change of the glymphatic system in idiopathic normal pressure hydrocephalus (iNPH) using diffusion tensor imaging (DTI) analysis. Materials and Methods. 24 right-handed patients were referred to our hydrocephalus clinic for assessment of ventriculomegaly and gait impairment. 12 of 24 were diagnosed as pseudo-iNPH (piNPH) based on assessment by a neurologist. Diffusivity maps in the direction of the x-axis (right-to-left) (Dx), y-axis (anterior-to-posterior) (Dy), and z-axis (inferior-to-superior) (Dz) were computed. The diffusion map was coregistered to International Consortium for Brain Mapping (ICBM) DTI-81 atlas. The analysis along the perivascular space (ALPS) index was defined as mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where Dxpro and Dxasc are Dx values in the projection and association fiber areas, respectively. Evans index and callosal angle were also assessed on each case. Results. ALPS indexes of the control, piNPH, and iNPH cases were 1.18 ± 0.08, 1.08 ± 0.03, and 0.94 ± 0.06, respectively, and there were significant differences among the groups (control vs. piNPH, P = 0.003; control vs. iNPH P < 0.001; piNPH vs. iNPH, P < 0.001). Area under curve (AUC) was 0.92, 1.00, and 1.00 on control vs. piNPH, control vs. iNPH, and piNPH vs. iNPH on ROC analysis. Between piNPH and NPH, ALPS index has higher diagnostic performance than Evans index and callosal angle (AUC = 1.00 vs. 0.84, P = 0.028; AUC = 1.00 vs. 0.74, P = 0.016). Conclusion. Atlas-based ALPS index using the DTI method differentiated among iNPH, piNPH, and controls clearly.

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