Beyond Ventricular Enlargement: Multimodal MRI Assessment Improves Surgical Decision-Making in Normal Pressure...

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Normal pressure hydrocephalus (NPH) diagnosis relies on clinical assessment and lumbar puncture, but predicting shunt surgery success remains challenging.
• Magnetic Resonance Imaging (MRI) offers morphometric and qualitative parameters that may aid in NPH evaluation.

Purpose of the Study:

• To assess the effectiveness of MRI-based morphometric and qualitative features in identifying patients with suspected NPH who would benefit from shunt surgery.
• To determine independent predictors of shunt surgery selection in NPH patients.

Main Methods:

• Retrospective analysis of 134 participants (84 symptomatic NPH patients, 50 controls).
• Categorization of symptomatic patients into shunt surgery and conservative management groups.
• Analysis of MRI parameters including Evans index, fronto-occipital horn ratio (FOHR), bicaudate index, callosal angle, ventricular measurements, and disproportionately enlarged subarachnoid space hydrocephalus (DESH) components.
• ROC analysis and logistic regression to assess discriminatory performance and identify predictors.

Main Results:

• Conventional ventricular indices were larger in symptomatic patients than controls (p < 0.001).
• Baseline MRI measurements did not significantly differ between shunt and conservative groups (p > 0.05).
• High-convexity tightness and an Evans Index > 0.36 were independently associated with shunt surgery selection.

Conclusions:

• Ventricular width-based MRI indices alone are insufficient for selecting NPH patients for shunt surgery.
• Qualitative and quantitative MRI features, specifically high-convexity tightness and Evans Index > 0.36, are key predictors for shunt surgery selection.
• Integrating multimodal imaging with clinical evaluation enhances the reliability of identifying NPH patients for shunt surgery.