Aqueductal CSF Stroke Volume Is Increased in Patients with Idiopathic Normal Pressure Hydrocephalus and Decreases after Shunt Surgery

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Fig 1.
Timeline. MRI indicates MR imaging with the phase-contrast MR imaging sequence; Clinical inv., clinical investigation with tests of gait function, cognition, and urinary symptoms; HC, age- and sex-matched healthy controls. Preop = preoperative investigations; Postop, postoperative follow-up.
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Fig 2.
A, Aqueductal cerebral stroke volume in patients with iNPH and healthy controls. The lines connect each patient with a matched control. B, Aqueductal cerebral stroke volume in patients with iNPH at baseline, the day before shunt surgery (preop), and at 3 months after the operation (postop). Error bars represent 10th and 90th percentiles. The asterisk indicates P < .05; double asterisks, P < .01; NS, not significant.
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Fig 3.
A, Sagittal T2-weighted turbo spin-echo image (without flow compensation) with the red line illustrating the location of the phase-contrast MR imaging scan plane. B, Transverse magnitude image through the aqueduct. The red circle illustrates the ROI drawn for flow measurements. C, Corresponding velocity (phase) image.
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Fig 4.
Aqueductal CSF flow during 1 cardiac cycle. Positive values are in the craniocaudal direction.

Table 1:

Demographics and background data in patients and controls^{^a}

Note:—DWMH indicates deep white matter hyperintensities; DESH, disproportionately enlarged subarachnoid space hydrocephalus; NS, not significant.
↵a Unless indicated otherwise, data are median, with IQR in parenthesis.
↵b Mann-Whitney U test.
↵c McNemar test.
↵d Wilcoxon signed rank test.

Table 2:

Aqueductal stroke volume, peak velocity, and aqueductal area in controls and patients at baseline^{^a}

Table 3:

Aqueductal stroke volume, peak velocity, and aqueductal area in patients at all assessment times^{^a}

	Patient Baseline (n = 21)	Patient Preop (n = 16)	Patient Postop (n = 17)	P Value
ACSV (μL)	103.5 (69.8–142.8)	94.8 (81–241)	88 (51.8–173.3)	<.05^{^b}
Peak velocity (mm/s)	103 (68.5–166.5)	127 (72.5–154.8)	108 (71.5–146.5)	NS
Net flow (μL)	−1.6 (−19–14)	−1.8 (−14.5–10.8)	0 (−12.5–2.1)	NS
Aq area (mm²)	22 (19–25)	22.5 (19.3–25.8)	24 (20.5–25.5)	NS

Note:—Preop indicates preoperative; Postop, postoperative; Aq, aqueductal; NS, not signifiicant.
↵a Data are median with interquartile range in parentheses.
↵b Wilcoxon signed rank test. Significant difference between baseline and postoperative investigation and between preoperative and postoperative investigation. Comparisons between baseline and preoperative measurements were all nonsignificant.