The Evans’ Index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly

Brix, Maiken K.; Westman, Eric; Simmons, Andrew; Ringstad, Geir; Eide, Per Kristian; Wagner-Larsen, Kari; Page, Christian M.; Vitelli, Valeria; Beyer, Mona K.

doi:10.1016/j.ejrad.2017.07.013

Cited by 88 publications

(95 citation statements)

References 30 publications

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“…[ 5 ] In our recent study, iNPH patients with EI ≤0.3 was observed at 30% and with non-DESH at 55% of 84 definite iNPH patients. [ 6 ] Similar results have been reported from other laboratories suspecting the reliability of DESH[ 7 8 ] Regarding EI, 29% of healthy elderly people have EI >0.3,[ 9 ] and there is no clear basis for using EI >0.3 as an index of ventriculomegaly, and it is inconsistent. The cases have been also reported that the symptoms were improved by CSF shunting despite EI ≤0.3.…”

Section: Introductionsupporting

confidence: 72%

Magnetic resonance imaging findings of idiopathic normal pressure hydrocephalus and cognitive function before and after ventriculoatrial shunt

Watahiki

Onouchi²,

Machida

et al. 2020

Asian J Neurosurg

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Background: The idiopathic normal pressure hydrocephalus (iNPH) is characterized by the triad of gait impairment, incontinence, and dementia. Cases that do not comply with the diagnostic criteria of ventriculomegaly have increased. It has led to the questions about the current criteria of guidelines. As the number of patients with dementia increases with aging, iNPH is importantly placed as a treatable dementia. The purpose of this study was to verify the validity of radiological diagnostic criteria of ventriculomegaly in iNPH. Materials and Methods: A board-certified neuroradiologist retrospectively examined 80 patients with definite iNPH about magnetic resonance imaging (MRI) findings of Evans index (EI) and disproportionately enlarged subarachnoid space hydrocephalus (DESH). The score of mini-mental state examination (MMSE) was measured to represent the cognitive function. The presurgical score of MMSE (pre-MMSE) and postsurgical best score of MMSE (best-MMSE) were compared statistically between patients dichotomized by either EI >0.3 or DESH. Results: The pre-MMSE was not different regardless of dichotomization by EI >0.3 or DESH. The MMSE score (median) increased significantly ( P < 0.0001) by shunt from 20.0 to 26.0 in patients with EI >0.3 and from 21.5 to 25.5 with EI ≤0.3. No difference in the best-MMSE was observed between EI >0.3 and EI ≤0.3. The MMSE score increased significantly ( P < 0.0001) by shunt from 21 to 27.5 with DESH and from 20 to 24.5 with non-DESH. Regardless of fulfilling or notfulfilling Japanese radiological diagnostic criteria (combination of EI >0.3 and DESH), cognitive function was significantly ( P < 0.0001) improved to the same level. Only 24 cases (30%) fulfilled Japanese radiological diagnostic criteria. Conclusion: Cognitive function of iNPH patients was significantly improved by shunt regardless of MRI-findings. Radiological diagnostic criteria of iNPH may need careful reconsideration.

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Section: Introductionsupporting

confidence: 72%

Magnetic resonance imaging findings of idiopathic normal pressure hydrocephalus and cognitive function before and after ventriculoatrial shunt

Watahiki

Onouchi²,

Machida

et al. 2020

Asian J Neurosurg

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“…A combination of abnormal MTA and GCA also have a greater sensitivity and specificity for AD [15]. Evans’ index has been shown to increase with age but there is no significant difference between heathy elderly and patients with AD [22]. We believe that our results emphasize that MTA and PCA should be reported why we find the severe underreporting of MTA and PCA to be remarkable.…”

Section: Discussionmentioning

confidence: 61%

“…It gives an estimation of the size of the lateral ventricles and indirect estimation of central atrophy. Evans’ index was originally based on encephalographic measurements but has been modified for axial CT. New cut-offs corrected for age and gender have been proposed as follows (age, males/females): 65–69 years 0.34/0.32, 70–74 years 0.36/0.33, 75–79 years 0.37/0.34, and 80–84 years 0.37/0.36 [22]. For patients < 65 years EI ≥ 0.30 was considered pathological regardless of gender.…”

Section: Methodsmentioning

confidence: 99%

Structural imaging findings on non-enhanced computed tomography are severely underreported in the primary care diagnostic work-up of subjective cognitive decline

et al. 2019

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PurposeThe purpose of this study was to investigate how structural imaging findings of medial temporal lobe atrophy (MTA), posterior cortical atrophy (PCA), global cortical atrophy (GCA), white matter changes (WMC), and Evans’ index/width of lateral ventricles (EI/WLV) are reported in the primary care diagnostic work-up of patients with subjective cognitive decline or mild cognitive impairment.MethodsWe included 197 patients referred to a non-enhanced computed tomography (NECT) as part of the diagnostic work-up. We compared the frequencies of reported findings in radiology reports written by neuroradiologists and general radiologists with actual pathological findings in a second view done by a single neuroradiologist using the MTA, PCA, GCA, WMC, and EI/WLV visual rating scales. Structural findings were also compared to cognitive tests.ResultsWe found that MTA and PCA were clearly underreported by both neuroradiologists and general radiologists. The presence of GCA and WMC was also underreported among general radiologists. Only MTA showed a clear association with cognitive test results.ConclusionsWe believe that the use of visual rating scales should be put into clinical practice to increase the yield of clinical NECT exams in the investigation of cognitive impairment. Special emphasis should be put on reporting MTA.

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“…Both the international and the Japanese guidelines define ventricular enlargement as an Evans’ index greater than 0.3 1 , 4 . It has been generally used as an indirect, surrogate marker of ventricular volume 5 – 7 . Second, volumetric measurements have been recommended to represent an accurate estimate of true ventricular size 8 .…”

Section: Introductionmentioning

confidence: 99%

Lateral Ventricle Enlargement and Cortical Thinning in Idiopathic Normal-pressure Hydrocephalus Patients

Kang

Kwak

Yoon

et al. 2018

Sci Rep

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We utilized three-dimensional, surface-based, morphometric analysis to investigate ventricle shape between 2 groups: (1) idiopathic normal-pressure hydrocephalus (INPH) patients who had a positive response to the cerebrospinal fluid tap test (CSFTT) and (2) healthy controls. The aims were (1) to evaluate the location of INPH-related structural abnormalities of the lateral ventricles and (2) to investigate relationships between lateral ventricular enlargement and cortical thinning in INPH patients. Thirty-three INPH patients and 23 healthy controls were included in this study. We used sparse canonical correlation analysis to show correlated regions of ventricular surface expansion and cortical thinning. Significant surface expansion in the INPH group was observed mainly in clusters bilaterally located in the superior portion of the lateral ventricles, adjacent to the high convexity of the frontal and parietal regions. INPH patients showed a significant bilateral expansion of both the temporal horns of the lateral ventricles and the medial aspects of the frontal horns of the lateral ventricles to surrounding brain regions, including the medial frontal lobe. Ventricular surface expansion was associated with cortical thinning in the bilateral orbitofrontal cortex, bilateral rostral anterior cingulate cortex, left parahippocampal cortex, left temporal pole, right insula, right inferior temporal cortex, and right fusiform gyrus. These results suggest that patients with INPH have unique patterns of ventricular surface expansion. Our findings encourage future studies to elucidate the underlying mechanism of lateral ventricular morphometric abnormalities in INPH patients.

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The Evans’ Index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly

Abstract: The range of the EI measurements in healthy elderly is wide, and a cut-off value of 0.3 cannot be used to differentiate between normal and enlarged ventricles in individual cases. The proposed EI thresholds from the present study show good sensitivity for the iNPH diagnosis.

Cited by 88 publications

References 30 publications

Magnetic resonance imaging findings of idiopathic normal pressure hydrocephalus and cognitive function before and after ventriculoatrial shunt

Magnetic resonance imaging findings of idiopathic normal pressure hydrocephalus and cognitive function before and after ventriculoatrial shunt

Structural imaging findings on non-enhanced computed tomography are severely underreported in the primary care diagnostic work-up of subjective cognitive decline

Lateral Ventricle Enlargement and Cortical Thinning in Idiopathic Normal-pressure Hydrocephalus Patients

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