Institute of Neurology, University "Magna Graecia", Catanzaro, Italy.
Neuroscience Research Center, University "Magna Graecia", Catanzaro, Italy.
Mov Disord. 2020 Aug;35(8):1406-1415. doi: 10.1002/mds.28087. Epub 2020 May 12.
Idiopathic normal pressure hydrocephalus and PSP share several clinical and radiological features, making differential diagnosis, at times, challenging.
To differentiate idiopathic normal pressure hydrocephalus from PSP using MR volumetric and linear measurements.
Twenty-seven idiopathic normal pressure hydrocephalus patients, 103 probable PSP patients, and 43 control subjects were consecutively enrolled. Automated ventricular volumetry was performed using Freesurfer 6 on MR T -weighted images. Linear measurements, such as callosal angle and a new measure, termed MR Hydrocephalic Index, were calculated on MR T -weighted images. Receiver operating characteristic analyses were used for differentiating between patient groups. Generalizability and reproducibility of the results were validated, dividing each participant group in two cohorts used as training and testing subsets.
Ventricular volumes and linear measurements (callosal angle and Magnetic Resonance Hydrocephalic Index) revealed greater ventricular enlargement in patients with idiopathic normal pressure hydrocephalus than in PSP patients and controls. PSP patients had ventricular volume larger than controls. Automated ventricular volumetry and Magnetic Resonance Hydrocephalic Index were the most accurate measures (98.5%) in differentiating patients with idiopathic normal pressure hydrocephalus from PSP patients, whereas callosal angle misclassified several PSP patients and showed low positive predictive value (70.0%) in differentiating between these two diseases. All measurements accurately differentiated idiopathic normal pressure hydrocephalus patients from controls. Accuracy values obtained in the training set (automated ventricular volumetry, 98.4%; Magnetic Resonance Hydrocephalic Index, 98.4%; callosal angle, 87.5%) were confirmed in the testing set.
Our study demonstrates that AVV and Magnetic Resonance Hydrocephalic Index were the most accurate measures for differentiation between idiopathic normal pressure hydrocephalus and PSP patients. Magnetic Resonance Hydrocephalic Index is easy to measure and can be used in clinical practice to prevent misdiagnosis and ineffective shunt procedures in idiopathic normal pressure hydrocephalus mimics. © 2020 International Parkinson and Movement Disorder Society.
特发性正常压力脑积水和 PSP 具有一些相似的临床和影像学特征，这使得鉴别诊断有时具有挑战性。
使用磁共振容积和线性测量来区分特发性正常压力脑积水和 PSP。
连续纳入 27 例特发性正常压力脑积水患者、103 例可能的 PSP 患者和 43 名对照。使用 Freesurfer 6 在磁共振 T1 加权图像上进行自动脑室容积测量。在线性测量方面，如胼胝体角和新的测量指标——磁共振脑积水指数，是在磁共振 T1 加权图像上计算得出的。采用受试者工作特征分析来区分患者组。通过将每个参与者组分为两个用作训练和测试子集的队列，验证结果的可推广性和可重复性。
与 PSP 患者和对照组相比，特发性正常压力脑积水患者的脑室容积和线性测量（胼胝体角和磁共振脑积水指数）显示出更大的脑室扩大。PSP 患者的脑室容积大于对照组。自动脑室容积测量和磁共振脑积水指数是区分特发性正常压力脑积水患者和 PSP 患者最准确的指标（98.5%），而胼胝体角则错误地分类了一些 PSP 患者，并且在区分这两种疾病时阳性预测值较低（70.0%）。所有测量均能准确区分特发性正常压力脑积水患者和对照组。在训练集中获得的准确性值（自动脑室容积测量，98.4%；磁共振脑积水指数，98.4%；胼胝体角，87.5%）在测试集中得到了证实。
我们的研究表明，AVV 和磁共振脑积水指数是区分特发性正常压力脑积水和 PSP 患者的最准确的指标。磁共振脑积水指数易于测量，可用于临床实践，以防止特发性正常压力脑积水类似物的误诊和无效分流手术。© 2020 国际帕金森病和运动障碍协会。
