Idiopathic Normal Pressure Hydrocephalus: Correlating Magnetic Resonance Imaging Biomarkers with Clinical Response

Abstract

Idiopathic Normal Pressure Hydrocephalus (NPH) is a debilitating condition of the elderly. The patient is typically “wet, wobbly and wonky”, to different degrees of the triad. The diagnosis is supported by the radiologic finding of dilated ventricles, determined by an elevated Evan’s Index (EI) without a demonstrable cause. Patients with newly diagnosed NPH typically respond to ventriculo-peritoneal shunting (VPS). NPH-related dementia is possibly the only surgically reversible dementia. An elevated cerebrospinal fluid (CSF) flow rate (FR) is associated with a positive response to shunting. However, post-shunting EI and FRs are unpredictable. Of late, intracranial apparent diffusion coefficient (ADC) quantification via Diffusion Weighted Imaging (DWI) has been emerging as a possible marker in NPH diagnosis. A local study, conducted on a national level, to study the relationship of EI, FR and ADC to pre- and post-shunt clinical measurements has just ended. This review seeks to reconcile the current thinking of NPH, magnetic resonance imaging (MRI) quantification and clinical evaluation, and in the process shed some light on major pathophysiological determinants of the disease.

Neuroradiology: From Diagnosis to Intervention

“…The timely reviews in this issue, rich with illustrative images, into several complex clinical problems ranging from the very young to the more elderly age groups will be useful to both radiologists and clinicians in their daily practice. [11][12][13][14] Neuroradiology with its modern armamentarium, used a timely, appropriate manner, has vital contribution in clinical medicine and can guide further appropriate clinical, laboratory or imaging investigations. With the explosion in knowledge and technology, subspecialty expertise and collaboration is required to effectively harness these advances.…”

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“…Hence, the application of flowsensitive cardiac gated phase-contrast MR imaging techniques are integrated which is capable of providing significant care for the non-invasive study of CSF flow dynamics (Siraj, 2011). The CSF flow MRI has been found to show efficacy in differentiation between the communicating and noncommunicating hydrocephalus for localizing the level of obstruction in obstructive hydrocephalus and later providing important information concerning the preoperative evaluation of NPH, along with the differential diagnosis and the prediction of the related advantages from surgery and post-operative follow-up (Ng et al, 2009). Therefore, the utilization of different imaging techniques has been integrated for accessing the visualization of physiological processes and structural details along with diagnostic tests and prognostic tools utilized in assessing the patients suffering from NPH (Halperin et al, 2015).…”