Onder Halil, Goksungur Gurol
Neurology Clinic, Yozgat City Hospital, Yozgat, Turkey.
Radiology Clinic, Yozgat City Hospital, Yozgat, Turkey.
Ann Indian Acad Neurol. 2020 Sep-Oct;23(5):625-631. doi: 10.4103/aian.AIAN_583_19. Epub 2020 Dec 8.
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.
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.
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%).
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.
研究在脑脊液（CSF）穿刺试验反应呈阳性的正常压力脑积水（NPH）患者组中，先前定义的正常压力脑积水神经影像学征象的出现频率。
本研究纳入了22例疑似NPH患者和33名健康对照个体。在常规磁共振成像上评估先前定义的9个参数，包括埃文斯指数、高凸脑沟变窄、大脑外侧裂增宽、局灶性脑沟增宽、颞角增大、胼胝体角、脑室周围高信号、侧脑室顶部膨出以及蛛网膜下腔不成比例增宽脑积水。两组均形成了总放射学评分。比较患者组和健康对照组的总放射学评分、各放射学参数的评分及出现频率。
患者组的平均年龄为67.31±7.27（女性/男性比例为7/15），而健康对照组为69.09±4.89（女性/男性比例为11/22）。这些分析结果显示，除胼胝体角评分外，NPH患者组所有放射学参数的评分均更高。阳性预测值最高的参数是高凸脑沟变窄、胼胝体角变窄和蛛网膜下腔不成比例增宽脑积水（分别为100%、100%和100%）。另一方面，颞角增大在所有参数中具有最高的阴性预测值（96%）。
我们的研究结果支持将神经影像学参数用作脑脊液穿刺试验的替代方法。我们建议，在存在高凸脑沟变窄和/或胼胝体角变窄的情况下，对于疑似NPH的患者，可不进行脑脊液穿刺试验而做出分流手术的决定。未来，大规模研究肯定会为这些结果提供关键观点以供临床实践参考。
