Objective: To investigate the frequency of previously defined neuroimaging signs of normal pressure hydrocephalus in our NPH patient group with positive cerebrospinal fluid (CSF) tap test response. Methods: Twenty-two patients with probable NPH and 33 healthy control individuals were enrolled in this study. Previously defined 9 parameters including Evan’s index, narrow high convexity sulci, dilation of the Sylvian fissures, focally enlarged sulci, enlargement of the temporal horns, callosal angle, periventricular hyperintensities, bulging of the lateral ventricular roof, and disproportionately enlarged subarachnoid space hydrocephalus were evaluated on conventional magnetic resonance imaging. A total radiological score was formed in both groups. The total radiological score, scores, and frequency of each radiological parameters were compared between patient and healthy control groups. Results: The mean age of the patient group was 67.31 ± 7.27 (F/M ratio was 7/15), whereas it was 69.09 ± 4.89 (F/M ratio was 11/22) in healthy control group. The result of these analyses revealed that scores of all the radiological parameters, except callosal angle score, were found to be higher in NPH patient group. The parameters with the highest positive predictive values were narrow high convexity sulci, narrowing of callosal angle, and DESH (100%, 100%, and 100%, respectively). On the other hand, enlargement of temporal horns had the highest negative predictive value among all parameters (96%). Conclusion: The results of our study support the use of neuroimaging parameters as an alternative method for CSF tap test. We suggest that in the presence of narrow high convexity sulci and/or narrowing of callosal angle, the decision of shunt surgery may be made in patients with suspicion of NPH, without performing CSF tap test. Confirmation of these results, in the future, large-scale studies may certainly provide critical perspectives to be used in the clinical practice.


中文翻译：

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神经影像学参数在区分正常压力脑积水患者中的效用与健康对照组的阳性脑脊液抽头试验反应


目的：调查我们的 NPH 患者组中先前定义的正常压力脑积水的神经影像学症状的频率，脑脊液 (CSF) 敲击试验反应阳性。方法：22 名可能患有 NPH 的患者和 33 名健康对照者参加了这项研究。之前定义的 9 个参数包括埃文指数、狭窄的高凸面沟、外侧裂扩张、脑沟局部扩大、颞角扩大、胼胝体角、脑室周围高信号、侧脑室顶凸出和不成比例地扩大的蛛网膜下腔脑积水在传统的磁共振成像上。在两组中形成总放射学评分。在患者和健康对照组之间比较每个放射学参数的总放射学评分、评分和频率。结果：患者组的平均年龄为67.31±7.27（F/M比为7/15），而健康对照组为69.09±4.89（F/M比为11/22）。这些分析的结果表明，除了胼胝体角评分外，所有放射学参数的评分在 NPH 患者组中均较高。具有最高阳性预测值的参数是狭窄的高凸面沟、胼胝体角变窄和 DESH（分别为 100%、100% 和 100%）。另一方面，颞角扩大在所有参数中具有最高的阴性预测值（96%）。结论：我们的研究结果支持使用神经影像学参数作为脑脊液抽头测试的替代方法。我们建议在存在狭窄的高凸面沟和/或胼胝体角变窄的情况下，对怀疑 NPH 的患者可以做出分流手术的决定，而无需进行 CSF 敲击试验。对这些结果的确认，在未来，大规模的研究肯定会为临床实践提供重要的观点。