Diffusion tensor imaging helps identify shunt-responsive normal pressure hydrocephalus patients among probable iNPH...

Area of Science:

• Neuroimaging
• Neurology
• Medical Diagnostics

Background:

• Idiopathic normal pressure hydrocephalus (iNPH) presents with gait disturbance, cognitive decline, and ventriculomegaly.
• Differentiating iNPH from other neurological conditions with similar symptoms is clinically challenging.
• Diffusion tensor imaging (DTI) offers insights into white matter integrity.

Purpose of the Study:

• To assess if DTI-measured white matter changes can differentiate shunt-responsive iNPH from non-iNPH conditions.
• To compare DTI metrics between iNPH patients, non-iNPH patients, and healthy controls.

Main Methods:

• Prospective study of 85 probable iNPH patients undergoing preoperative MRI and clinical assessment.
• Diagnosis of iNPH confirmed by clinical symptoms, positive lumbar infusion test, and gait improvement after CSF drainage.
• Fractional anisotropy (FA) and mean diffusivity (MD) values extracted from white matter regions of interest using FSL's TBSS pipeline.
• Comparison of DTI metrics between iNPH, non-iNPH, and 13 age/sex-matched healthy controls.

Main Results:

• Significant differences in FA values were observed between iNPH patients and healthy controls.
• Statistically significant FA differences were also found between iNPH and non-iNPH patient groups.
• The uncinate fasciculus demonstrated the highest diagnostic ability (AUC=0.74) in differentiating iNPH within the probable iNPH cohort.

Conclusions:

• Standardized DTI analysis of white matter using region of interest extraction can aid in iNPH diagnosis.
• DTI is a valuable tool for differentiating iNPH from healthy individuals.
• DTI assists in distinguishing iNPH from other conditions causing gait disturbances, cognitive decline, and ventriculomegaly.