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Automated Midline Shift and Intracranial Pressure Estimation based on Brain CT Images
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Quantitative imaging features predict spinal tap response in normal pressure hydrocephalus.

Eyal Lotan1, Brianna E Damadian2, Henry Rusinek3

  • 1Department of Radiology, New York University Langone Medical Center, 660 1st Ave, 2nd Floor, New York, NY, 10016, USA. elotan@gmail.com.

Neuroradiology
|August 21, 2021
PubMed
Summary

High-volume lumbar puncture (HVLP) and continuous lumbar drain (cLD) response in normal pressure hydrocephalus (NPH) can be predicted by specific MRI findings. Smaller callosal angles and third/fourth ventricular volumes, along with larger hippocampal volumes, indicate a positive response.

Keywords:
MRINormal pressure hydrocephalusSpinal tapVolumetric analysis

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Area of Science:

  • Neuroimaging
  • Neurosurgery
  • Neurology

Background:

  • High-volume lumbar puncture (HVLP) and continuous lumbar drain (cLD) are utilized to predict shunt response in patients with suspected normal pressure hydrocephalus (NPH).
  • Identifying reliable predictors of shunt response is crucial for optimizing treatment strategies in NPH patients.

Purpose of the Study:

  • To investigate differences in MRI volumetric and traditional measures between HVLP/cLD responders and non-responders.
  • To identify imaging features that may help predict HVLP/cLD response in suspected NPH patients.

Main Methods:

  • Retrospective study of 82 patients with suspected NPH undergoing gait testing and pre-procedure brain MRI.
  • MRI analysis included 3D T1-weighted sequences for subcortical volume segmentation (FreeSurfer), Evans' index, callosal angle (CA), and disproportionately enlarged subarachnoid space hydrocephalus.
  • Statistical analyses included ANCOVA, chi-square tests, and multivariable logistic regression to identify predictive metrics.

Main Results:

  • No significant differences in total ventricular, white matter, or gray matter volumes between responders and non-responders.
  • Responders showed smaller callosal angles (in men) and third/fourth ventricular volumes, and larger hippocampal volumes (p < 0.05).
  • Temporal horn volume correlated with gait velocity improvement (p = 0.0006); the regression model achieved 76.8% accuracy in predicting HVLP/cLD response.

Conclusions:

  • Callosal angle, third and fourth ventricular volumes, and hippocampal volume are potential imaging predictors of spinal tap response.
  • These imaging features may aid in predicting shunt response in patients with suspected NPH.
  • Further research can validate these imaging biomarkers for improved clinical decision-making in NPH management.