Abstract
Background and PurposeAs magnetic resonance imaging (MRI) signs of normal pressure hydrocephalus (NPH) may precede clinical symptoms we sought to evaluate an algorithm that automatically detects this pattern.MethodsA support vector machine (SVM) was trained in 30 NPH patients treated with ventriculoperitoneal shunts and 30 healthy controls. For comparison, four neuroradiologists visually assessed sagittal MPRAGE images and graded them as no NPH pattern, possible NPH pattern, or definite NPH pattern.ResultsHuman accuracy to visually detect a NPH was between 0.85 and 0.97. Interobserver agreement was substantial (κ = 0.656). Accuracy of the SVM algorithm was 0.93 and AUROC 0.99. Among 272 prespecified regions, gray matter and CSF volumes of both caudate, the right parietal operculum, the left basal forebrain, and the 4th ventricle showed the highest discriminative power to separate a NPH and a no NPH pattern.ConclusionA NPH pattern can be reliably detected using a support vector machine (SVM). Its role in the work-up of asymptomatic patients or neurodegenerative disease has to be evaluated.
Highlights
Normal pressure hydrocephalus (NPH) is a brain disorder in which excess cerebrospinal fluid (CSF) accumulates in the subarachnoid and ventricular spaces
A total of 30 patients were included in the normal pressure hydrocephalus (NPH) group and 30 healthy controls (HC) served as control group
One patient was lost in follow-up and another patient died after surgery due to acute respiratory distress syndrome
Summary
Normal pressure hydrocephalus (NPH) is a brain disorder in which excess cerebrospinal fluid (CSF) accumulates in the subarachnoid and ventricular spaces. It is defined as increased CSF volume without continuous elevation of the intracranial pressure, whereas the complete pathomechanism is still unclear [1]. NPH is caused by other brain disorders such as a tumor, head injury, hemorrhage, infection or inflammation. Studies indicate that the development of NPH underlies a prolonged process since radiographic findings show volumetric changes 3 or more years before the onset of clinical symptoms [3]. As magnetic resonance imaging (MRI) signs of normal pressure hydrocephalus (NPH) may precede clinical symptoms we sought to evaluate an algorithm that automatically detects this pattern. Four neuroradiologists visually assessed sagittal MPRAGE images and graded them as no NPH pattern, possible NPH pattern, or definite NPH pattern
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