Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
Clin Neurol Neurosurg. 2024 Jul;242:108362. doi: 10.1016/j.clineuro.2024.108362. Epub 2024 May 31.
There are currently many imaging indicators for idiopathic normal pressure hydrocephalus (iNPH). However, their diagnostic performance has not been well compared, especially in differentiating iNPH from Alzheimer's disease (AD). This study aimed to evaluate the diagnostic performance of these imaging indicators in differentiating iNPH from AD.
We retrospectively collected patients with iNPH from the West China Hospital between June 2016 and December 2023. Age-sex-matched patients with AD and healthy controls (HCs) are included as controls (ChiCTR2300070078, March 2023). Twelve imaging indicators were evaluated on MRI, including disproportionately enlarged subarachnoid space hydrocephalus (DESH), Evans' index (EI), callosal angle, z-EI, temporal horn, dilated Sylvian fissure, focal sulcal dilation, tight high convexity, deep white matter hyperintensities, periventricular hyperintensities, DESH scale, and Simplified Radscale. We analyzed the receiver operating characteristic curves and calculated the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy.
A total of 46 patients with iNPH (mean age: 73.1 ± 6.5; 35 males), 46 patients with AD (mean age: 73.0 ± 6.6; 35 males), and 46 HCs (mean age: 73.0 ± 5.9; 35 males) were included. The largest area under the receiver operating characteristic curve (AUC) was found in EI (0.93; 95 % CI: 0.89-0.98) and z-EI (0.93; 95 % CI: 0.87-0.98). DESH scale ≥ 6 had the highest specificity (93 %, 43/46).
EI and z-EI had the best diagnostic performance in differentiating iNPH from AD. The DESH scale could assist in diagnosing iNPH due to its high specificity.
特发性正常压力脑积水（iNPH）有许多影像学指标。然而，它们的诊断性能尚未得到很好的比较，尤其是在鉴别 iNPH 与阿尔茨海默病（AD）方面。本研究旨在评估这些影像学指标在鉴别 iNPH 与 AD 中的诊断性能。
我们回顾性收集了 2016 年 6 月至 2023 年 12 月期间华西医院的 iNPH 患者。将年龄性别匹配的 AD 患者和健康对照组（HCs）作为对照（ChiCTR2300070078，2023 年 3 月）。在 MRI 上评估了 12 个影像学指标，包括不成比例扩大的蛛网膜下腔脑积水（DESH）、Evans 指数（EI）、胼胝体角、z-EI、侧脑室、扩大的侧裂、局灶性脑沟扩张、紧张性高凸、深部白质高信号、脑室周围高信号、DESH 量表和简化 Radscale。我们分析了受试者工作特征曲线，并计算了敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）和准确性。
共纳入 46 例 iNPH 患者（平均年龄：73.1±6.5；35 名男性）、46 例 AD 患者（平均年龄：73.0±6.6；35 名男性）和 46 名 HCs（平均年龄：73.0±5.9；35 名男性）。最大的受试者工作特征曲线下面积（AUC）在 EI（0.93；95%CI：0.89-0.98）和 z-EI（0.93；95%CI：0.87-0.98）中发现。DESH 量表≥6 具有最高的特异性（93%，43/46）。
EI 和 z-EI 在鉴别 iNPH 与 AD 方面具有最佳的诊断性能。DESH 量表由于其高特异性，可辅助诊断 iNPH。
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