The idiopathic normal‐pressure hydrocephalus Radscale: a radiological scale for structured evaluation

Kockum, Karin; Lilja-Lund, Otto; Larsson, Elna-Marie; Rosell, Michelle; Söderström, Lars; Virhammar, Johan; Laurell, Katarina

doi:10.1111/ene.13555

Cited by 96 publications

(104 citation statements)

References 29 publications

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“…Also, high convexity tightness was reported to be strongly associated with gait, in terms of postoperative improvement [19]. It should be noted that other radiological features, such as temporal horn width and periventricular hypodensities, have previously been reported to be associated with symptoms of iNPH [30]. These were not assessed in the present study and hence the association between imaging features and symptoms of iNPH needs further study.…”

Section: Discussionmentioning

confidence: 65%

The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

Akiba

Gyanwali

Villaraza

et al. 2020

Journal of the Neurological Sciences

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Introduction: Disproportionately Enlarged Subarachnoid space Hydrocephalus (DESH) is considered as an important imaging feature of idiopathic normal pressure hydrocephalus (iNPH). Method: Subjects aged 60 and over in a memory clinic and a community-based cohort were assessed for the presence of ventriculomegaly, Sylvian dilatation, and high convexity tightness by neuroimaging, and a clinical triad of iNPH symptoms, i.e. cognitive, gait and urinary symptoms. Results: In the memory clinic-based study (548 subjects), the prevalence of DESH was 1.1% and increased with age. The clinical triad was significantly more frequent in subjects with DESH (50%) compared to those with normal images (none), Sylvian dilatation (7%), and ventriculomegaly (12%). Gait disturbance was also significantly more frequent in DESH (83%) compared to those with normal images (2%), Sylvian dilatation (14%), and ventriculomegaly (26%). In the community-based cohort (946 subjects), the prevalence of DESH was 1.0% and increased with age. The clinical triad (11%) was significantly more common in subjects with DESH compared to those with normal images (none), Sylvian dilatation (2%), and ventriculomegaly (7%). Gait disturbance was also significantly more common in DESH (33%) compared to those with normal images (1%), Sylvian dilatation (4%), and ventriculomegaly (10%). Conclusion: The reported prevalence of DESH was approximately 1%, and increased with age. DESH and high convexity tightness were specifically associated with the clinical triad of iNPH. Of the triad, gait disturbance was associated to DESH and high convexity tightness. 1. Introduction With rapidly aging societies globally, the medical care of the elderly has become an important social issue. As aging is the strongest risk factor for dementia, the burden of dementia is increasing worldwide, and has major impact on quality of life as well as the economy [1,2]. Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease of the elderly, marked by triad of symptoms:

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Section: Discussionmentioning

confidence: 65%

The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

Akiba

Gyanwali

Villaraza

et al. 2020

Journal of the Neurological Sciences

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“…Our findings of only weak correlations between ventricular dilation or white matter changes on the one hand and symptom severity on the other differ markedly from a recent study reporting an association between 8 CT-based imaging markers and the severity of clinical symptoms. 7 The cited study used the iNPH grading scale, 4 and the statistical analysis was performed using linear regression modeling, which we were unable to reproduce given the absence of a linear relationship between our dependent and independent variables and non-normal data distribution.…”

Section: Discussionmentioning

confidence: 99%

“…1 The connection between radiologic findings and symptoms in iNPH has also recently been reinforced with the use of a composite scale score including morphologic CT findings in patients with iNPH. 7 The use of morphologic MR imaging markers for selecting appropriate shunt surgery candidates has been investigated, but results vary; the use of these markers for predictive purposes is still disputed. [8][9][10][11][12] DESH 13 has won support as a prognostic marker, 14 most recently by Shinoda et al, 15 who developed a 10-point grading scale to aid in patient selection for surgery.…”

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confidence: 99%

Absence of Disproportionately Enlarged Subarachnoid Space Hydrocephalus, a Sharp Callosal Angle, or Other Morphologic MRI Markers Should Not Be Used to Exclude Patients with Idiopathic Normal Pressure Hydrocephalus from Shunt Surgery

Agerskov

Wallin

Hellström

et al. 2018

AJNR Am J Neuroradiol

101

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BACKGROUND AND PURPOSE: Several studies have evaluated the use of MR imaging markers for the prediction of outcome after shunt surgery in idiopathic normal pressure hydrocephalus with conflicting results. Our aim was to investigate the predictive value of a number of earlier proposed morphologic MR imaging markers in a large group of patients with idiopathic normal pressure hydrocephalus. MATERIALS AND METHODS: One hundred sixty-eight patients (mean age, 70 Ϯ 9.3 years) with idiopathic normal pressure hydrocephalus, subjected to standardized quantification of clinical symptoms before and after shunt surgery, were included in the study. Outcome was calculated using a composite score. Preoperative T1, FLAIR, and flow-sensitive images were analyzed regarding the presence of 13 different morphologic MR imaging markers. RESULTS: The median Evans index was 0.41 (interquartile range, 0.37-0.44). All patients had an aqueductal flow void sign present and white matter hyperintensities. The median callosal angle was 68.8°(interquartile range, 57.7°-80.8°). Dilated Sylvian fissures were found in 69%; focally dilated sulci, in 25%; and widening of the interhemispheric fissure, in 55%. Obliteration of the sulci at the convexity was found in 36%, and 36% of patients were characterized as having disproportionately enlarged subarachnoid space hydrocephalus. Sixty-eight percent of patients improved after surgery. None of the investigated MR imaging markers were significant predictors of improvement after shunt surgery. CONCLUSIONS: Disproportionately enlarged subarachnoid space hydrocephalus, a small callosal angle, and the other MR imaging markers evaluated in this study should not be used to exclude patients from shunt surgery. These markers, though they may be indicative of idiopathic normal pressure hydrocephalus, do not seem to be a part of the mechanisms connected to the reversibility of the syndrome. ABBREVIATIONS: DESH ϭ disproportionately enlarged subarachnoid space hydrocephalus; EI ϭ Evans index; iNPH ϭ idiopathic normal pressure hydrocephalus

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“…Symptom scales have been launched in order to structure the clinical assessment, and to allow comparison of symptoms over time and between sites [7,8]. The iNPH Radscale [9] was introduced as a screening tool to structure the assessment of radiological features associated with iNPH and includes mandatory and supportive radiological parameters listed in both diagnostic guidelines [3,4]. The seven parameters of the scale derive from previous research [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus

et al. 2020

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Background and purpose The idiopathic normal pressure hydrocephalus (iNPH) Radscale was developed to standardize the evaluation of radiological signs in iNPH. The purpose of this study was to estimate the diagnostic accuracy of the iNPH Radscale in a sample of "true positive" and "true negative" cases. Methods Seventy-five patients with definite iNPH, i.e. who had improved at clinical follow-up one year after ventriculoperitoneal shunt surgery, were compared with 55 asymptomatic individuals from the general population. A radiologist assessed the seven radiological features of the iNPH Radscale in computed tomography of the brain in the patients (preoperatively) and controls. Results The iNPH Radscale score was significantly higher in the iNPH group (Median = 10, interquartile range 9-11) than in the control group (Median = 1, interquartile range 1-2) (p <0.001). Receiver operated characteristics analysis yielded an area under the curve of 99.7%, and an iNPH Radscale score � 4 identified those without iNPH, with a sensitivity of 100%, specificity of 96% and overall accuracy of 98.5%. Conclusions In this study, iNPH Radscale could accurately discriminate between patients with definite iNPH and asymptomatic individuals over 65 years old. According to the results, a diagnosis of iNPH is very likely in patients with an iNPH Radscale score above 8 and corresponding clinical symptoms. On the other hand, the diagnosis should be questioned when the iNPH Radscale score is below the cutoff level of 4. We conclude that the iNPH Radscale could

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The idiopathic normal‐pressure hydrocephalus Radscale: a radiological scale for structured evaluation

Abstract: The iNPH Radscale may become a valuable diagnostic screening tool, allowing a structured radiological assessment. A high iNPH Radscale score together with clinical symptoms should raise suspicion of iNPH, motivating further evaluation for shunt surgery.

Cited by 96 publications

References 29 publications

The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

Absence of Disproportionately Enlarged Subarachnoid Space Hydrocephalus, a Sharp Callosal Angle, or Other Morphologic MRI Markers Should Not Be Used to Exclude Patients with Idiopathic Normal Pressure Hydrocephalus from Shunt Surgery

Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus

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