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      High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus

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          Abstract

          Sixty patients with idiopathic normal pressure hydrocephalus underwent presurgical brain MR imaging and clinical evaluation before and 1 year after shunt surgery. The authors assessed the MR imaging features including Evans index, high-convexity tightness, Sylvian fissure dilation, callosal angle, focal enlargement of the cortical sulci, bumps in the lateral ventricular roof, and deep white matter and periventricular hyperintensities. Multiple linear regression analyses demonstrated that presurgical high-convexity tightness alone predicted the improvement of the clinical symptoms 1 year after surgery.

          Abstract

          BACKGROUND AND PURPOSE:

          Although neuroimaging plays an important role in the diagnosis of idiopathic normal pressure hydrocephalus, its predictive value for response to shunt surgery has not been established. The purpose of the current study was to identify neuroimaging markers that predict the shunt response of idiopathic normal pressure hydrocephalus.

          MATERIALS AND METHODS:

          Sixty patients with idiopathic normal pressure hydrocephalus underwent presurgical brain MR imaging and clinical evaluation before and 1 year after shunt surgery. The assessed MR imaging features included the Evans index, high-convexity tightness, Sylvian fissure dilation, callosal angle, focal enlargement of the cortical sulci, bumps in the lateral ventricular roof, and deep white matter and periventricular hyperintensities. The idiopathic normal pressure hydrocephalus grading scale total score was used as a primary clinical outcome measure. We used measures for individual symptoms (ie, the idiopathic normal pressure hydrocephalus grading scale subdomain scores, such as gait, cognitive, and urinary scores), the Timed Up and Go test, and the Mini-Mental State Examination as secondary clinical outcome measures. The relationships between presurgical neuroimaging features and postoperative clinical changes were investigated by using simple linear regression analysis. To identify the set of presurgical MR imaging features that best predict surgical outcomes, we performed multiple linear regression analysis by using a bidirectional stepwise method.

          RESULTS:

          Simple linear regression analyses demonstrated that presurgical high-convexity tightness, callosal angle, and Sylvian fissure dilation were significantly associated with the 1-year changes in the clinical symptoms. A multiple linear regression analysis demonstrated that presurgical high-convexity tightness alone predicted the improvement of the clinical symptoms 1 year after surgery.

          CONCLUSIONS:

          High-convexity tightness is a neuroimaging feature predictive of shunt response in idiopathic normal pressure hydrocephalus.

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          Most cited references28

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          Visualization of an Oxygen-deficient Bottom Water Circulation in Osaka Bay, Japan

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            Validation of Grading Scale for Evaluating Symptoms of Idiopathic Normal-Pressure Hydrocephalus

            Background/Aims: We developed an idiopathic normal-pressure hydrocephalus grading scale (iNPHGS) to classify a triad of disorders (cognitive impairment, gait disturbance and urinary disturbance) of iNPH with a wide range of severity. The purpose of this study was to assess the reliability and validity of this scale in 38 patients with iNPH. Results: The interrater reliability of this scale was high. The iNPHGS cognitive domain score significantly correlated with the cognitive test scores, including the Mini-Mental State Examination (MMSE), the gait domain score with the Up and Go Test and Gait Status Scale scores, and the urinary domain score with the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. The MMSE, Gait Status Scale and ICIQ-SF scores significantly improved in patients whose iNPHGS scores improved after CSF tapping but not in those whose iNPHGS scores did not improve after CSF tapping. Fourteen of the 38 patients received shunt operations. In these 14 patients, changes in the iNPHGS cognitive and urinary domains after CSF tapping were significantly associated with the changes after the shunt operation.
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              AN ENCEPHALOGRAPHIC RATIO FOR ESTIMATING VENTRICULAR ENLARGEMENT AND CEREBRAL ATROPHY

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                Author and article information

                Journal
                AJNR Am J Neuroradiol
                AJNR Am J Neuroradiol
                ajnr
                ajnr
                AJNR
                AJNR: American Journal of Neuroradiology
                American Society of Neuroradiology
                0195-6108
                1936-959X
                October 2016
                : 37
                : 10
                : 1831-1837
                Affiliations
                [1] aFrom the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
                [2] bNeurosurgery (M.I., T.T.), Tohoku University School of Medicine, Sendai, Japan.
                Author notes
                Please address correspondence to Wataru Narita, MD, Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, 2–1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; e-mail: naritaw@ 123456med.tohoku.ac.jp , or Yoshiyuki Nishio, MD, PhD, Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, 2–1, Seiryo-machi, Aoba-ku, Sendai 980-8575 Sendai, Japan; e-mail: nishiou@ 123456med.tohoku.ac.jp
                Author information
                http://orcid.org/0000-0001-9634-6695
                http://orcid.org/0000-0002-6857-1200
                http://orcid.org/0000-0003-0936-2510
                http://orcid.org/0000-0003-1563-0729
                http://orcid.org/0000-0002-9001-1998
                http://orcid.org/0000-0001-5431-9891
                http://orcid.org/0000-0002-4204-7144
                http://orcid.org/0000-0003-3411-2900
                http://orcid.org/0000-0003-4247-9948
                Article
                PMC7960449 PMC7960449 7960449 16-00123
                10.3174/ajnr.A4838
                7960449
                27365329
                6b6df5ff-f213-408c-91ea-6918c8a4c1d7
                © 2016 by American Journal of Neuroradiology

                Indicates open access to non-subscribers at www.ajnr.org

                History
                : 10 February 2016
                : 18 April 2016
                Categories
                Adult Brain
                Fellows' Journal Club

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