Spatially resolved periventricular ADC profiling in normal pressure hydrocephalus: an exploratory pilot study

To explore whether boundary-anchored apparent diffusion coefficient (ADC) profiling can characterize periventricular diffusion patterns in normal pressure hydrocephalus (NPH).

Seventeen patients with shunted NPH with baseline and postoperative follow-up ADC maps acquired at 1.5 T or 3 T and 17 age-, sex-, and scanner-matched controls were analyzed retrospectively. A short anchor was placed along the frontal horn ventricular boundary. ADC values were sampled along approximately orthogonal lines and summarized as amplitude- and shape-related profile metrics. Patient-control and longitudinal within-patient comparisons were analyzed with false-discovery-rate correction for multiple comparisons.

At baseline, patients showed a higher reference ADC, inner-zone mean ADC, outer-zone mean ADC, and outer plateau ADC than controls. At follow-up, amplitude-related ADC differences persisted. Longitudinally, the profile multiphasicity index, inner peak ADC, and initial profile slope changed after shunting and remained significant after FDR correction, whereas most amplitude-related metrics remained stable.

Boundary-anchored ADC profiling identified persistent periventricular ADC differences and selected postoperative profile changes in NPH. The findings are exploratory and require validation.

· Boundary-anchored ADC profiling describes periventricular diffusion patterns in NPH.. · NPH showed persistent amplitude-related ADC differences versus matched controls.. · Selected shape-related profile metrics changed after shunt surgery.. · Findings are exploratory and require validation in larger cohorts..

· Garner M, Fries F, Garner C et al. Spatially resolved periventricular ADC profiling in normal pressure hydrocephalus: an exploratory pilot study. Rofo 2026; DOI 10.1055/a-2970-7054.