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Research ArticleBrain

Preoperative Prognostic Value of MRI Findings in 108 Patients with Idiopathic Normal Pressure Hydrocephalus

J. Virhammar, K. Laurell, K.G. Cesarini and E.-M. Larsson
American Journal of Neuroradiology December 2014, 35 (12) 2311-2318; DOI: https://doi.org/10.3174/ajnr.A4046
J. Virhammar
aFrom the Departments of Neuroscience and Neurology (J.V., K.L.)
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K. Laurell
aFrom the Departments of Neuroscience and Neurology (J.V., K.L.)
dDepartment of Pharmacology and Clinical Neuroscience (K.L.), Östersund, Umeå University, Umeå, Sweden.
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K.G. Cesarini
bNeuroscience and Neurosurgery (K.G.C.)
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E.-M. Larsson
cRadiology (E.-M.L.), Uppsala University, Uppsala, Sweden
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Abstract

BACKGROUND AND PURPOSE: MR imaging is used in the diagnostic evaluation of patients with idiopathic normal pressure hydrocephalus. The aim of this study was to describe the prevalence of several imaging features and their prognostic use in the selection of shunt candidates with idiopathic normal pressure hydrocephalus.

MATERIALS AND METHODS: Preoperative MR imaging scans of the brain were retrospectively evaluated in 108 patients with idiopathic normal pressure hydrocephalus who had undergone a standardized, clinical evaluation before and 12 months after shunt surgery. The MR imaging features investigated were the Evans index, callosal angle, narrow sulci at the high convexity, dilation of the Sylvian fissure, diameters of the third ventricle and temporal horns, disproportionately enlarged subarachnoid space hydrocephalus, flow void through the aqueduct, focal bulging of the roof of the lateral ventricles, deep white matter hyperintensities, periventricular hyperintensities, and focal widening of sulci and aqueductal stenosis.

RESULTS: In logistic regression models, with shunt outcome as a dependent variable, the ORs for the independent variables, callosal angle, disproportionately enlarged subarachnoid space hydrocephalus, and temporal horns, were significant (P < .05), both in univariate analyses and when adjusted for age, sex, and previous stroke.

CONCLUSIONS: A small callosal angle, wide temporal horns, and occurrence of disproportionately enlarged subarachnoid space hydrocephalus are common in patients with idiopathic normal pressure hydrocephalus and were significant predictors of a positive shunt outcome. These noninvasive and easily assessed radiologic markers could aid in the selection of candidates for shunt surgery.

ABBREVIATIONS:

DESH
disproportionately enlarged subarachnoid space hydrocephalus
DWMH
deep white matter hyperintensities
ICC
intraclass correlation coefficient
iNPH
idiopathic normal pressure hydrocephalus
NPH
normal pressure hydrocephalus
PVH
periventricular hyperintensities
SINPHONI
Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement
  • © 2014 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 35 (12)
American Journal of Neuroradiology
Vol. 35, Issue 12
1 Dec 2014
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Cite this article
J. Virhammar, K. Laurell, K.G. Cesarini, E.-M. Larsson
Preoperative Prognostic Value of MRI Findings in 108 Patients with Idiopathic Normal Pressure Hydrocephalus
American Journal of Neuroradiology Dec 2014, 35 (12) 2311-2318; DOI: 10.3174/ajnr.A4046

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Preoperative Prognostic Value of MRI Findings in 108 Patients with Idiopathic Normal Pressure Hydrocephalus
J. Virhammar, K. Laurell, K.G. Cesarini, E.-M. Larsson
American Journal of Neuroradiology Dec 2014, 35 (12) 2311-2318; DOI: 10.3174/ajnr.A4046
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Cited By...

  • Can Shunt Response in Patients with Idiopathic Normal Pressure Hydrocephalus Be Predicted from Preoperative Brain Imaging? A Retrospective Study of the Diagnostic Use of the Normal Pressure Hydrocephalus Radscale in 119 Patients
  • Prognostic Utility of Disproportionately Enlarged Subarachnoid Space Hydrocephalus in Idiopathic Normal Pressure Hydrocephalus Treated with Ventriculoperitoneal Shunt Surgery: A Systematic Review and Meta-analysis
  • Aqueductal CSF Stroke Volume Is Increased in Patients with Idiopathic Normal Pressure Hydrocephalus and Decreases after Shunt Surgery
  • Absence of Disproportionately Enlarged Subarachnoid Space Hydrocephalus, a Sharp Callosal Angle, or Other Morphologic MRI Markers Should Not Be Used to Exclude Patients with Idiopathic Normal Pressure Hydrocephalus from Shunt Surgery
  • High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus
  • Quantitative MRI for Rapid and User-Independent Monitoring of Intracranial CSF Volume in Hydrocephalus
  • Optimal Diagnostic Indices for Idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space
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