Can Shunt Response in Patients with Idiopathic Normal Pressure Hydrocephalus Be Predicted from Preoperative Brain Imaging? A Retrospective Study of the Diagnostic Use of the Normal Pressure Hydrocephalus Radscale in 119 Patients

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FIG 1.
MR imaging of a 79-year-old female shunt-responder with an NPH Radscale score of 11. A, Coronal FLAIR image shows marked bilateral Sylvian fissure dilation (white arrows), apical narrowing of sulci (white elipse), a narrow CA (65°), and marked periventricular hyperintensities. B–D, Axial T2 images at different levels show measurement of third ventricle diameter (white line), sulcal dilation (white arrow), and measurements used for the Evans ratio calculation (black lines).
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FIG 2.
A boxplot of NPH Radscale values (y-axis) for responders and nonresponders, respectively. The thick black line is the median; and box upper and lower margins are 75th and 25th percentiles, respectively. Whiskers represent upper and lower ranges.

Table 1:

Distribution of different imaging parameters for the entire population for responders and nonresponders

	Score	Total	Responders	Nonresponders	P Value
Patients (No.)		119	94	25
EI^{^a}		0.39 (0.046)	0.39 (0.046)	0.38 (0.046)	.28^{^c}
CA^{^a}		73.0 (17.4)	71.9 (16.7)	77.2 (19.7)	.23^{^c}
Third ventricle diameter^{^a}		14.2 (3.14)	14.3 (3.00)	14.1 (3.72)	.75^{^c}
Mean temporal horn diameter^{^a}		8.14 (2.40)	8.38 (2.40)	7.26 (2.22)	.03^{^c}
NPH Radscale^{^a}		8.17 (1.56)	8.35 (1.53)	7.48 (1.53)	.02^{^c}
DESH^{^b}	Present	60 (50.4%)	49 (52.1%)	11 (44%)	.47^{^d}
	Not present	59 (49.6%)	45 (47.9%)	14 (56%)
Focal bulging	Present	14 (11.8%)	12 (12.8%)	2 (8.0%)	.73^{^e}
	Not present	105 (88.2%)	82 (87.2%)	23 (92.0%)
Focally enlarged sulci^{^b}	Present	22 (18.5%)	17 (18.1%)	5 (20.0%)	.78^{^e}
	Not present	97 (81.5%)	77 (81.9%)	20 (80.0%)
Sylvian fissure dilation^{^b}	Present	101 (84.9%)	83 (88.3%)	18 (72.0%	.05^{^e}
	Not present	18 (15.1%)	11 (11.7%)	7 (28%)
Narrow sulci^{^b}	2	47 (39.5%)	29 (30.9%)	4 (16.0%)	.19^{^f}
	1	39 (32.8%)	30 (31.9%)	9 (36.0%)
	0	33 (27.7%)	35 (37.2%)	12 (48.0%)
PVWML^{^b}	2	55 (46.2%)	47 (50.0%)	8 (32.0%)	.16^{^f}
	1	47 (39.5%)	34 (36.2%)	13 (52.0%)
	0	17 (14.3%)	13 (13.8%)	4 (16.0%)

Table 2:

Interrater correlations for continuous evaluations for MR imaging and CT

Note:—LB indicates lower bound; UB, upper bound; ICC, intraclass correlation coefficient.

Table 3:

Kappa statistics for binary categorical evaluations for MR imaging and CT

Note:—κ Indicates Kappa statistics; LB, lower bound; UB, upper bound; DESH, disproportionately enlarged subarchmoid space hydroceplaus.