Narita W, Nishio Y, Baba T, Iizuka O, Ishihara T, Matsuda M, Iwasaki M, Tominaga T, Mori E
From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.)
From the Departments of Behavioral Neurology and Cognitive Neuroscience (W.N., Y.N., T.B., O.I., T.I., M.M., E.M.).
AJNR Am J Neuroradiol. 2016 Oct;37(10):1831-1837. doi: 10.3174/ajnr.A4838. Epub 2016 Jun 30.
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.
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.
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.
High-convexity tightness is a neuroimaging feature predictive of shunt response in idiopathic normal pressure hydrocephalus.
尽管神经影像学在特发性正常压力脑积水的诊断中发挥着重要作用，但其对分流手术反应的预测价值尚未确立。本研究的目的是识别可预测特发性正常压力脑积水分流反应的神经影像学标志物。
60例特发性正常压力脑积水患者在分流手术前、后接受了术前脑磁共振成像和临床评估。评估的磁共振成像特征包括埃文斯指数、高凸部紧绷度、大脑外侧裂扩张、胼胝体角、皮质沟的局灶性增宽、侧脑室顶部隆起以及深部白质和脑室周围高信号。特发性正常压力脑积水分级量表总分用作主要临床结局指标。我们将个体症状的测量指标（即特发性正常压力脑积水分级量表子域评分，如步态、认知和排尿评分）、计时起立行走测试和简易精神状态检查用作次要临床结局指标。通过简单线性回归分析研究术前神经影像学特征与术后临床变化之间的关系。为了确定最能预测手术结果的术前磁共振成像特征集，我们采用双向逐步法进行了多元线性回归分析。
简单线性回归分析表明，术前高凸部紧绷度、胼胝体角和大脑外侧裂扩张与临床症状的1年变化显著相关。多元线性回归分析表明，仅术前高凸部紧绷度可预测术后1年临床症状的改善。
高凸部紧绷度是预测特发性正常压力脑积水分流反应的神经影像学特征。
