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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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  • Fig 1.
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    Fig 1.

    Nine different patients with iNPH. A, Evans index = x/y. B, Callosal angle. C, Narrow medial sulci and 2 focally dilated sulci on the left side. D, DESH. E, A flow void in the aqueduct and fourth ventricle graded as 2. In addition, a flow void in the foramina of Monro. F, Large diameter of the third ventricle. G, Dilated temporal horns. H, DWMH graded as 3 in a patient who also has PVH. I, PVH graded as 2.

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    Fig 2.

    T1-weighted 3D images of a patient with iNPH. A and B, Coronal images illustrate the different heights of the Sylvian fissure that can be achieved depending on the angulation of the section. B, The Sylvian fissure ordinal. C, Sagittal image with orientation lines represented by the coronal images A and B.

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    Fig 3.

    Two patients with focal bulging of the roof of the lateral ventricles. Sagittal images include the most cranial portions of the lateral ventricles. A, T2-weighted image. B, T1-weighted image.

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    Fig 4.

    Forest plot with sex-adjusted odds ratios for all imaging features. OR with a 95% CI of 1-SD increase for continuous variables and a 1-U increase for dichotomous and ordinal variables. An arrow indicates that the confidence interval extends beyond the range of the plot. The Sylvian fissure ordinal is the ordinal scale 0–2; the Sylvian fissure height is measured in millimeters. The asterisk indicates P < .05.

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    Table 1:

    Interrater reliability between 2 independent investigators for all imaging findings

    Imaging FeatureReliability
    Evans index (ICC)0.93
    Callosal angle (ICC)0.95
    Narrow sulci (κ)0.64
    Sylvian fissure original (κ)a0.36
    Sylvian fissure ordinal (κ)b0.62
    Sylvian fissure height (ICC) (mm)0.89
    DESHcNA
    Flow void (κ)0.33
    Focal bulging (κ)0.28
    Third ventricle (ICC)0.96
    Temporal horns (ICC)0.80
    DWMH (κ)0.67
    PVH (κ)0.72
    Focally enlarged sulci (κ)0.54
    Aqueductal stenosis (κ)0.32
    • Note:—NA indicates not applicable.

    • ↵a The original method to measure the Sylvian fissure.7

    • ↵b Ordinal scale of 0–2.

    • ↵c Calculated from Sylvian fissure ordinal and narrow sulci.

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    Table 2:

    Prevalence and grading of imaging findings measured on dichotomous and ordinal scales

    Imaging Feature (Grading Range)Frequency of Different Grading (No.) (%)aSample (No.)
    0123
    Sylvian fissure ordinal (0–2)23 (21)77 (71)8 (8)NA108
    DESH (0–1)36 (33)72 (67)NANA108
    Flow void (0–3)b0 (0)0 (0)9 (25)27 (75)36
    Narrow sulci (0–2)24 (22)22 (20)62 (58)NA108
    Focal bulging (0–1)13 (12)95 (88)NANA108
    DWMH (0–3)5 (5)11 (10)31 (29)60 (56)107
    PVH (0–2)27 (25)66 (62)14 (13)NA107
    Focally enlarged sulci (0–1)45 (42)63 (58)NANA108
    Aqueductal stenosis (0–1)105 (97)3 (3)NANA108
    • Note:—NA indicates not applicable.

    • ↵a Dichotomous variables: 0 = not present, 1 = present.

    • ↵b Flow void in the aqueduct and fourth ventricle.

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    Table 3:

    Correlations among different imaging markers at baselinea

    Imaging FeatureSignificant Correlations
    Evans indexThird ventricle (r = 0.39b)
    Callosal angleDESH (r = −0.27c), focal bulging (r = −0.28c), temporal horns (r = −0.33d)
    DESHFocal bulging (r = 0.34d), focally enlarged sulci (r = 0.32d), callosal angle (r = −0.27c)
    Focal bulgingTemporal horns (r = 0.26c), callosal angle (r = −0.28c), DESH (r = 0.34d)
    Third ventricleTemporal horns (r = 0.38b)
    DWMHPVH (r = 0.68b)
    • Note:—r indicates Spearman correlation coefficient.

    • ↵a Measurements of Sylvian fissure and narrow sulci at the high convexity were not included because they are components of DESH.

    • ↵b P < .0001.

    • ↵c P < .01.

    • ↵d P < .001.

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American Journal of Neuroradiology: 35 (12)
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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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  • 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
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  • 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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