The NPH radscale; a new radiological scale for evaluation of suspected normal pressure hydrocephalus

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

doi:10.1186/2045-8118-12-s1-p27

Cited by 4 publications

(5 citation statements)

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“…Radiology is also pivotal in the diagnosis of iNPH; however, until recently, studies have not been able to show an association between radiological features and SR [ 33 ]. The iNPH Radscale may potentially play an important role in SR prediction and is a promising new tool in the iNPH patient workup [ 32 ]. However, due to its relatively recent introduction in 2017, there is currently insufficient literature evaluating its use.…”

Section: Discussionmentioning

confidence: 99%

“…However, due to its relatively recent introduction in 2017, there is currently insufficient literature evaluating its use. Although Kockum et al [ 32 ] have reported 98.5% predictive accuracy of NPH Radscale, another study found it to be unable to predict motor outcomes post-shunting [ 35 ]. Nonetheless, the literature on the role of radiology in iNPH is extensive; hence, the authors believe that a separate meta-analysis on the role of radiological tools in the prediction of SR is required.…”

Section: Discussionmentioning

confidence: 99%

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Clinical predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

et al. 2021

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Background Positive shunt response (SR) remains the gold standard for diagnosing idiopathic normal pressure hydrocephalus (iNPH). However, multiple pathologies mimic iNPH symptoms, making it difficult to select patients who will respond to shunt surgery. Although presenting features, extended lumbar drainage (ELD), infusion test (IT), intracranial pressure monitoring (ICPM), and tap test (TT) have been used to predict SR, uncertainty remains over which diagnostic test to choose. Objective To conduct a systematic review and meta-analysis to identify clinical predictors of shunt responsiveness, evaluate their diagnostic effectiveness, and recommend the most effective diagnostic tests. Methods Embase, MEDLINE, Scopus, PubMed, Google Scholar, and JSTOR were searched for original studies investigating clinical predictors of SR in iNPH patients. Included studies were assessed using the QUADAS-2 tool, and eligible studies were evaluated using univariate and bivariate meta-analyses. Results Thirty-five studies were included. Nine studies discussed the diagnostic use of presenting clinical features, 8 studies ELD, 8 studies IT, 11 studies ICPM, and 6 studies TT. A meta-analysis of 21 eligible studies was conducted for TT, ELD, IT, and ICPM. ICPM yielded the highest diagnostic effectiveness, with diagnostic odds ratio (DOR) = 50.9 and area under curve (AUC) = 0.836. ELD yielded DOR = 27.70 and AUC = 0.753, IT had DOR = 5.70 and AUC = 0.729, and TT scored DOR = 3.86 and AUC = 0.711. Conclusion Intraparenchymal ICPM is statistically the most effective diagnostic test, followed by ELD, IT, and lastly TT. Due to the higher accessibility of TT and IT, they are recommended to be used first line, using a timed-up-and-go improvement ≥ 5.6 s or a Rout cut-off range between 13 and 16 mmHg, respectively. Patients who test negative should ideally be followed up with ICPM, using mean ICP wave amplitude $$\ge$$ ≥ 4 mmHg, or 1- to 4-day ELD with an MMSE cut-off improvement $$\ge$$ ≥ 3. Future research must use standardized methodologies for each diagnostic test and uniform criteria for SR to allow better comparison.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

et al. 2021

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“…Radiologically, it is characterized by enlarged lateral and third ventricles, disproportionally to cortical sulci enlargement, as depicted by brain imaging, either with computed tomography (CT) or magnetic resonance imaging (MRI) [ 8 ]. Increased Evans index, temporal horns dilation, periventricular white matter lesions, narrow callosal angle and sulci in the convexity, focally enlarged sulci and dilated Sylvian fissures are additional imaging findings that have been described [ 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 97%

Cerebrospinal Fluid Biomarkers in iNPH: A Narrative Review

et al. 2022

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Idiopathic normal pressure hydrocephalus (iNPH) is a neurological syndrome characterized by the clinical triad of gait disorder, cognitive impairment and urinary incontinence. It has attracted interest because of the possible reversibility of symptoms, especially with timely treatment. The main pathophysiological theory is based on a vicious circle of disruption in circulation of cerebrospinal fluid (CSF) that leads to the deceleration of its absorption. Data regarding CSF biomarkers in iNPH are contradictory and no definite CSF biomarker profile has been recognized as in Alzheimer’s disease (AD), which often co-exists with iNPH. In this narrative review, we investigated the literature regarding CSF biomarkers in iNPH, both the established biomarkers total tau protein (t-tau), phosphorylated tau protein (p-tau) and amyloid peptide with 42 amino acids (Aβ42), and other molecules, which are being investigated as emerging biomarkers. The majority of studies demonstrate differences in CSF concentrations of Aβ42 and tau-proteins (t-tau and p-tau) among iNPH patients, healthy individuals and patients with AD and vascular dementia. iNPH patients present with lower CSF Aβ42 and p-tau concentrations than healthy individuals and lower t-tau and p-tau concentrations than AD patients. This could prove helpful for improving diagnosis, differential diagnosis and possibly prognosis of iNPH patients.

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“…However, many of the individual imaging parameters described in various studies lack adequate sensitivity and specificity [ 12 ]. To this end, a structured scale for the overall evaluation of imaging data has been proposed by Kockum et al, in 2015 and 2018, the so-called Radscale [ 13 , 14 ]. It is a calibrated imaging scale, consisting of morphological features of iNPH, and is thought to be capable of assessing the severity and possibly the effectiveness of the therapeutic intervention.…”

Section: Introductionmentioning

confidence: 99%

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Pyrgelis

Paraskevas

Constantinides

et al. 2022

JCM

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The aim of the present study was the implementation of the composite imaging “Radscale” in patients with idiopathic normal pressure hydrocephalus (iNPH) and the evaluation of its score, as well as absolute stroke volume and peak flow velocity of cerebrospinal fluid (CSF) in aqueduct as indicators of a positive response following a tap test. Forty-five patients with iNPH were included. Clinical evaluation involved the 10 m timed walk test before and every 24 h for 3 consecutive days after evacuative lumbar puncture (LP). Neuropsychological evaluation comprised a mini mental state examination (MMSE), frontal assessment battery (FAB), 5-word test (5WT) and CLOX drawing test 1 and 2, which were carried out before and 48 h after LP. The tap test’s response was defined as a ≥20% improvement in gait and/or a ≥10% improvement in neuropsychological tests. All scores of neuropsychological and clinical variables, except for immediate 5WT and CLOX-1, differed significantly before and 48 h after LP. Improvement in time and steps of a 10 m timed walk test differed significantly between female and male patients. Out of 45 total patients, 19 were tap test responders and 26 non-responders. The total score of Radscale and CSF flow parameters did not differ between responders and non-responders. However, “Callosal angle” sub-score differed significantly between these two groups. A greater “callosal angle” sub-score, meaning more acute callosal angle, was associated with a positive tap test response, rendering it a useful measurement in the stratification of iNPH patients that will potentially respond to CSF shunting.

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The NPH radscale; a new radiological scale for evaluation of suspected normal pressure hydrocephalus

Cited by 4 publications

References 1 publication

Clinical predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Clinical predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Cerebrospinal Fluid Biomarkers in iNPH: A Narrative Review

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

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