From the Department of Radiology (J.F.C., C.A.M., A.E.H.)
Department of Radiology (A.D.L.B.), Hospital of North Zealand, Hillerød, Denmark.
AJNR Am J Neuroradiol. 2022 Feb;43(2):223-229. doi: 10.3174/ajnr.A7378. Epub 2021 Dec 30.
The Normal Pressure Hydrocephalus Radscale is a combined scoring of 7 different structural imaging markers on preoperative brain CT or MR imaging in patients with idiopathic normal pressure hydrocephalus: callosal angle, Evans Index, Sylvian fissure dilation, apical sulcal narrowing, mean temporal horn diameter, periventricular WM lesions, and focal sulcal dilation. The purpose of this retrospective study was to assess the performance of the Normal Pressure Hydrocephalus Radscale in distinguishing idiopathic normal pressure hydrocephalus shunt responders from nonresponders.
The preoperative MR imaging and CT scans of 119 patients with idiopathic normal pressure hydrocephalus were scored using the Normal Pressure Hydrocephalus Radscale. A summary shunt-response score assessed within 6 months from ventriculoperitoneal shunt surgery, combining the effect on cognition, gait, and urinary incontinence, was used as a reference. The difference between the mean Normal Pressure Hydrocephalus Radscale for responders and nonresponders was tested using the Student test. The area under the curve was calculated for the Normal Pressure Hydrocephalus Radscale to assess shunt response. To ascertain reproducibility, we assessed the interobserver agreement between the 2 independent observers as intraclass correlation coefficients for the Normal Pressure Hydrocephalus Radscale for 74 MR imaging scans and 19 CT scans.
Ninety-four (79%) of 119 patients were shunt responders. The mean Normal Pressure Hydrocephalus Radscale score for shunt responders was 8.35 (SD, 1.53), and for nonresponders, 7.48 (SD, 1.53) (= .02). The area under the curve for the Normal Pressure Hydrocephalus Radscale was 0.66 (range, 0.54-0.78). The intraclass correlation coefficient for the Normal Pressure Hydrocephalus Radscale was 0.86 for MR imaging and 0.82 for CT.
The Normal Pressure Hydrocephalus Radscale showed moderate discrimination for shunt response but cannot, on its own, be used for selecting patients with idiopathic normal pressure hydrocephalus for shunt surgery.
常压脑积水 Radscale 评分是一种综合评分，基于术前脑 CT 或磁共振成像上 7 种不同的结构影像学标志物，用于特发性常压脑积水患者：胼胝体角、Evans 指数、大脑外侧裂扩张、脑回顶部脑沟变窄、颞角平均直径、脑室周围白质病变和局部脑沟扩张。本回顾性研究旨在评估常压脑积水 Radscale 评分对特发性常压脑积水分流术患者的反应能力。
对 119 例特发性常压脑积水患者的术前磁共振成像和 CT 扫描进行常压脑积水 Radscale 评分。采用 6 个月内脑室腹腔分流术的认知、步态和尿失禁综合效果评估的简单分流反应评分作为参考。采用学生 t 检验比较分流反应者和非反应者的常压脑积水 Radscale 评分均值差异。通过计算常压脑积水 Radscale 评分的曲线下面积来评估分流反应。为了确定重复性，我们评估了 2 位独立观察者之间的观察者间一致性，采用 74 例磁共振成像扫描和 19 例 CT 扫描的常压脑积水 Radscale 评分的组内相关系数来评估。
119 例患者中 94 例（79%）为分流反应者。分流反应者的常压脑积水 Radscale 评分均值为 8.35（标准差，1.53），而非反应者为 7.48（标准差，1.53）（P=.02）。常压脑积水 Radscale 评分的曲线下面积为 0.66（范围，0.54-0.78）。磁共振成像的常压脑积水 Radscale 评分的组内相关系数为 0.86，CT 为 0.82。
常压脑积水 Radscale 评分对分流反应有中等的区分能力，但不能单独用于选择特发性常压脑积水患者进行分流手术。
