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MR Fingerprinting Predicts Gait Improvement After Lumbar Cerebrospinal Fluid Drainage for Normal Pressure
R Sky Jones1, Jacqueline Chen2, Doksu Moon2
1Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
Background:
Normal pressure hydrocephalus (NPH) results in gait disturbance, but clinical response to extended lumbar drainage (ELD) of cerebrospinal fluid varies. Noninvasive predictors of response are needed.
Purpose:
To determine whether MR fingerprinting (MRF) findings have potential as a quantifiable biomarker for predicting clinical response to ELD in patients with NPH.
Study Type:
Prospective cohort.
Population:
Twenty individuals with NPH (mean age 77.7 years; 11 male sex).
Field Strength/Sequence:
3T; 2D T1,T1/T2 MRF, 3D T1.
Assessment:
Patients with NPH referred for ELD between August 2020 and February 2023 were recruited and underwent brain MRI and 10 m walking test before and after ELD. Clinical response was defined as improvement in the walking test plus a positive neurosurgical assessment. Quantitative T 1 and T 2 values were obtained using MRF. Whole-brain T 1 and T 2 times were obtained for cerebral white matter (WM) and gray matter (GM). Brain volumetry was derived using a 3DT1-weighted sequence.
Statistical Tests:
Linear discriminants to predict responder status were derived from logistic regression against T 1 and T 2 times; supplementary discriminants from visual inspection (manual delineation) were created as well. Fisher's exact test was applied to resulting contingency tables with significance at p < 0.05. Receiver operating characteristic curves were generated to assess predictors.
Results:
There were 11 responders and 9 nonresponders. Pretreatment MRF demonstrated an ability to distinguish responders from nonresponders (areas under the curve: WM T 1, 0.83 ± 0.21; GM T 1, 0.76 ± 0.23; WM T 2, 0.81 ± 0.22; GM T 2, 0.81 ± 0.22). Via logistic regression, GM measures significantly predicted responder status (OR = 14.0 [1.54, 130]) but WM measures did not (p = 0.37). Visual inspection yielded significance for GM (OR incalculable due to zero-valued contingency cell) and WM (OR = 18.7 [1.56, 222]).
Data Conclusion:
Elevated whole-brain T 1 and T 2 relaxation times may serve as a noninvasive predictive biomarker of response to ELD in patients with NPH.
Evidence Level:
2 TECHNICAL EFFICACY: Stage 2.
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