Using the iNPH Radscale as a Radiological Predictor of Clinical Outcomes after Ventriculoperitoneal Shunt Placement in Patients with Idiopathic Normal Pressure Hydrocephalus (iNPH) (P9-11.014)

Abstract

<h3>Objective:</h3> To determine the utility of the iNPH Radscale in predicting clinical outcomes of VPS placement in patients with NPH. <h3>Background:</h3> NPH is treated by placement of a VPS; however, there is no standardized approach to determining surgical candidacy. The iNPH Radscale is an established scoring system for CT/MRI scans that evaluates seven radiographic features characteristic of iNPH. A Radscale score of ≥8 suggests a high probability of an iNPH diagnosis. This study aimed to assess whether the pre-surgical iNPH Radscale could be used to help determine surgical candidacy. <h3>Design/Methods:</h3> Patients with a clinical diagnosis of NPH who underwent VPS placement between 1/1/10–6/30/21 were included in the study. The seven Radscale parameters were measured on patients’ pre-surgical MRIs. Patient charts were reviewed to determine clinical ambulation, cognition, and urination outcomes closest to one year post-VPS and were graded using the Clinical Global Impression Scale-Improvement (CGI-I). Chi-square and ANOVA were used to determine the relationship between total Radscale scores and CGI-I scores. The Fisher’s Exact Test was used to determine the association between each Radscale sub-score and CGI-I scores. <h3>Results:</h3> Out of 180 patients, 134 had complete Radscale scores and were included in this analysis. Fifty-nine percent had scores of ≥8, and 41% had scores &lt;8. Forty-seven percent had CGI-I ambulation scores that reflected significant improvement, and 45% demonstrated insignificant improvement or worse outcomes. There was no evidence of a significant association between the total Radscale score and CGI-I scores after VPS; nor was there evidence of a significant association between the Radscale sub-scores and CGI-I outcomes. <h3>Conclusions:</h3> This study suggests both total and sub-scores of the iNPH Radscale ratings based on pre-VPS placement imaging have no clear association with clinical improvement after VPS placement. Further research is needed to identify preoperative parameters that are predictive of positive shunt response. <b>Disclosure:</b> Miss Ghosh has nothing to disclose. Dr. Gilson has nothing to disclose. Dr. Kundrick has nothing to disclose. Mr. Baugher has nothing to disclose. The institution of Dr. Liao has received research support from American Parkinson Disease Association. Dr. Salles has nothing to disclose. Ms. Sonneborn has nothing to disclose. Olivia Hogue has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stoparkinson Healthcare Systems, LLC. Mr. Fellows has nothing to disclose. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevel. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Fernandez has received research support from Biogen. The institution of Dr. Fernandez has received research support from Michael J Fox Founda. The institution of Dr. Fernandez has received research support from Roche. The institution of Dr. Fernandez has received research support from Parkinson Foundation. The institution of Dr. Fernandez has received research support from UCB. Dr. Fernandez has received publishing royalties from a publication relating to health care. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as a Steering Committee/Advisory Committee Member with Parkinson Study Group. Sean Nagel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Sean Nagel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. The institution of Sean Nagel has received research support from Hydrocephalus Association.