Yang Yifeng, Yan Meijing, Sun Lianxi, Liu Xiao, Fang Xuhao, Li Shihong, Lin Guangwu
Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
Department of Neurosurgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
Fluids Barriers CNS. 2025 May 6;22(1):43. doi: 10.1186/s12987-025-00653-w.
Idiopathic normal-pressure hydrocephalus (iNPH) is a neurodegenerative disorder characterized by treatable cognitive impairment, remains poorly understood in terms of its underlying pathological mechanisms. Cortical morphological similarity network, which quantify synchronized morphological changes across brain regions, offer novel insights into inter-individual neuroanatomical variability. This study investigates individual-level cortical morphological network patterns in iNPH, explores their diagnostic utility and prognostic value for postoperative outcomes.
We enrolled 56 confirmed iNPH patients, 50 Alzheimer's disease (AD) patients, and 60 healthy controls (HC). Cortical morphological similarity networks were constructed using a morphometric inverse divergence network (MIND) framework, integrating five key cortical features: cortical thickness, mean curvature, sulcal depth, surface area, and cortical volume. Graph theory analysis was employed to quantify global and nodal network properties. Partial correlations with MMSE scores assessed network-cognition relationships. A LASSO-regularized support vector machine (SVM) classifier differentiated iNPH, AD, and HC groups using regional MIND similarity (MINDs) features. Finally, preoperative MRI-derived MINDs were integrated into a LASSO-regularized support vector regression (SVR) model to predict postoperative cognitive and gait improvements following shunt surgery.
Both iNPH and AD exhibited disrupted MIND network topology versus HC, including lower clustering coefficient, global efficiency, and local efficiency (all p < 0.05). Distinct spatial patterns emerged: iNPH showed localized lower values in cingulate subregions (degree centrality, node efficiency, MINDs), whereas AD demonstrated widespread alterations in fusiform, insular, and temporoparietal cortices. MMSE-associated MINDs in iNPH localized to frontostriatal circuits, contrasting with diffuse associations in AD. The multimodal classifier combining ventricular enlargement, regional brain volume, and MINDs achieved 87.00% accuracy (macro-AUC = 0.96) in three-group discrimination. Moreover, preoperative MINDs effectively predicted postoperative improvements in cognition and gait, with correlation coefficients of 0.941 and 0.889, respectively, between predicted and actual scores.
The MIND-based morphological similarity network reveals coordinated cortical morphological alterations in iNPH and highlights its heterogeneity compared to AD. These findings offer potential biomarkers to differentiate iNPH from AD. Furthermore, the predictive efficacy of MIND-based features for postoperative outcomes underscores their utility as non-invasive preoperative tools for evaluating shunt surgery effectiveness.
特发性正常压力脑积水（iNPH）是一种以可治疗的认知障碍为特征的神经退行性疾病，但其潜在病理机制仍知之甚少。皮质形态相似性网络可量化脑区之间同步的形态变化，为个体间神经解剖学变异性提供了新的见解。本研究调查了iNPH患者个体水平的皮质形态网络模式，探讨了它们对术后结果的诊断效用和预后价值。
我们纳入了56例确诊的iNPH患者、50例阿尔茨海默病（AD）患者和60名健康对照（HC）。使用形态计量逆散度网络（MIND）框架构建皮质形态相似性网络，该框架整合了五个关键皮质特征：皮质厚度、平均曲率、脑沟深度、表面积和皮质体积。采用图论分析来量化全局和节点网络属性。与MMSE评分的偏相关性评估网络与认知的关系。使用区域MIND相似性（MINDs）特征，通过套索正则化支持向量机（SVM）分类器区分iNPH、AD和HC组。最后，将术前MRI衍生的MINDs整合到套索正则化支持向量回归（SVR）模型中，以预测分流手术后的术后认知和步态改善情况。
与HC相比，iNPH和AD均表现出MIND网络拓扑结构破坏，包括聚类系数、全局效率和局部效率较低（均p < 0.05）。出现了不同的空间模式：iNPH在扣带回子区域显示局部较低值（度中心性、节点效率、MINDs），而AD在梭状回、岛叶和颞顶叶皮质表现出广泛改变。iNPH中与MMSE相关的MINDs定位于额纹状体回路，与AD中的弥漫性关联形成对比。结合脑室扩大、区域脑体积和MINDs的多模态分类器在三组区分中准确率达到87.00%（宏AUC = 0.96）。此外，术前MINDs有效地预测了术后认知和步态的改善，预测分数与实际分数之间的相关系数分别为0.941和0.889。
基于MIND的形态相似性网络揭示了iNPH中皮质形态的协调改变，并突出了其与AD相比的异质性。这些发现提供了区分iNPH与AD的潜在生物标志物。此外，基于MIND的特征对术后结果的预测效力强调了它们作为评估分流手术有效性的非侵入性术前工具的效用。
