Size Of Temporal Horns Research Articles

Can the radiological scale “iNPH Radscale” predict tap test response in idiopathic normal pressure hydrocephalus?

BackgroundIdiopathic normal pressure hydrocephalus (iNPH) presents typical radiological signs that have been summarised in a semi-quantitative scale named the iNPH Radscale. However, the iNPH Radscale's predictive value for response to cerebrospinal fluid (CSF) tap test has never been studied. This study aims to investigate if the iNPH Radscale can predict locomotion improvement after CSF tap test. MethodsA total of 100 patients with iNPH (age: 76.3 ± 7.9, gender: 36% female) were included in this retrospective study. Two raters, blinded to the response of the CSF tap test, evaluated the iNPH Radscale and its seven subitems (Evan's index, callosal angle, size of temporal horns, narrow high-convexity sulci, dilated Sylvian fissures, focally dilated sulci, and periventricular hypodensities). Locomotion improvement was assessed by the Timed Up and Go (TUG) performed before, and 24 h after, the CSF tap test. ResultsThe iNPH Radscale (total score) was similar between the CSF tap test responders and non-responders (responders: 8.31 ± 1.96, non-responders: 9.18 ± 2.51, p = 0.128). However, the temporal horns score was smaller in the responders group (1.66 ± 0.57 versus 1.94 ± 0.24, p = 0.045), even after adjusting for age, gender, education level, white matter changes, and global cognition (β: -0.250, C.I. 95%: [−3.185; −0.161], p = 0.031). ConclusionThe iNPH Radscale (total score) does not predict locomotion improvement after CSF tap test, while a smaller temporal horns score at baseline is associated with a positive tap test responder status.

Computerized predictive model for differential diagnosis of normal pressure hydrocephalus based on complex analysis of MRI image

Background. The main problem is to differentiate idiopathic normal pressure hydrocephalus (iNPH) with other neurodegenerative diseases accompanied by similar clinical presentation. For this purpose, a number of neuroimaging and invasive methods were proposed. The study objective is to assess most reliable magnetic resonance (MR) symptoms of iNPH and to create a prognostic model for differential diagnosis of iNPH by these criteria. Materials and methods. MR-data of 213 iNPH, 144 neurodegenerative (Alzheimer disease, Parkinson disease and early mild cognitive impairment) patients and 79 healthy age-matched controls were retrospectively analyzed. Following criteria were assessed: Evans Index, size of the third ventricle, size of temporal horns, disproportionately enlarged subarachnoid space hydrocephalus, focal convexital sulci enlargement, callosal angle, periventricular hyperintensities, focal subcortical gliosis and perivascular spaces enlargement. One-way ANOVA was used to explore differences between groups. Classification matrix was formed by discriminant analysis. Results. Differential model was established and Excel-tab-calculator was created for complex computed assessment of MR data and differential diagnosis of iNPH patients. Prognostic accuracy of model for iNPH reaches 99.5 %, for degenerative disorders – 89 %, common diagnostic accuracy is 92 %. Conclusion. Advantages of complex approach for assessment of MR-data in iNPH patients were underlined. Prognostic model for prediction of iNPH based on MR criteria was established.

The idiopathic normal-pressure hydrocephalus Radscale: a radiological scale for structured evaluation.

Despite the important role of imaging in diagnosing idiopathic normal-pressure hydrocephalus (iNPH), a structured overall assessment of radiological signs is still lacking. The purpose of this study was to construct a radiological scale, composed of morphological signs of iNPH, and compare it with clinical symptoms. In this prospective, population-based study of iNPH, 168 individuals (93 females) [mean age 75 (range 66-92)years] underwent computed tomography of the brain and a neurological examination with assessment of clinical symptoms according to Hellström's iNPH scale. Two radiologists, blinded to clinical data, independently evaluated and measured eight radiological parameters, i.e. Evans' index, callosal angle, size of temporal horns, narrow high-convexity sulci, dilated Sylvian fissures, focally dilated sulci, peri-ventricular hypodensities and bulging of the lateral ventricular roof. In a linear regression model, all parameters except ventricular roof bulging were significantly associated with clinical iNPH symptoms. The seven remaining parameters were summarized into a total iNPH Radscale score ranging from 0 to 12. There was a significant correlation (r=0.55, P<0.001) between the total iNPH Radscale score and clinical symptoms. The inter-rater agreement for the included radiological parameters was high (intraclass correlation, 0.74-0.97). The iNPH Radscale may become a valuable diagnostic screening tool, allowing a structured radiological assessment. A high iNPH Radscale score together with clinical symptoms should raise suspicion of iNPH, motivating further evaluation for shunt surgery.