Variability of Normal Pressure Hydrocephalus Imaging Biomarkers with Respect to Section Plane Angulation: How Wrong a Radiologist Can Be?

Ryška, Pavel; Slezák, Ondřej; Eklund, Anders; Salzer, Jonatan; Malm, Jan; Žižka, Ján

doi:10.3174/ajnr.a7095

Cited by 6 publications

(5 citation statements)

References 24 publications

(79 reference statements)

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“…It was initially established by Evans by measuring ventricular size in pediatric patients, with an EI >0.3 indicating ventricular enlargement 1 . Actually, the measurement of EI is affected by different imaging planes and angles 8 . However, under consistent measurement methods and imaging protocols, EI measurements are not only simple and rapid but also highly reproducible 9 …”

Section: Discussionmentioning

confidence: 99%

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Incidence of Ventriculomegaly in Patients With Craniosynostosis

Liu,

Li,

Zhang

et al. 2023

Journal of Craniofacial Surgery

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Hydrocephalus is variously associated with syndromic craniosynostosis (CS), while it is randomly encountered in nonsyndromic CS. But actually, the ventriculomegaly in CS is less described. In this study, the authors aim to establish whether ventriculomegaly is common in patients with CS, in both syndromic and nonsyndromic. Retrospective measurements of Evans index (EI) were taken from thin-section computed tomography scans of 169 preoperative CS patients to assess cerebral ventricular volume. EI >0.3 indicates ventricular enlargement. A total of 169 CS patients who underwent computed tomography scan from February 2018 to December 2021 were retrospectively evaluated, including 114 males and 55 females. The average age at diagnosis was 16 months (range: 1–103 mo). Among them, 37 with syndromic CS, including 17 ventricular megaly patients, had an EI >0.3 (46.0%), and 4 of them had intracranial hypertension and needed ventriculoperitoneal shunt treatment before cranial vault remolding. One hundred and thirty-two had nonsyndromic CS (100 single-suture CS, 32 multisuture CS), and 26 of them had an EI of 0.3 or greater (19.7%). Ventrocular megaly is common among patients with CS. Early craniotomy may stabilize ventricular dilation.

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Section: Discussionmentioning

confidence: 99%

“…1 Actually, the measurement of EI is affected by different imaging planes and angles. 8 However, under consistent measurement methods and imaging protocols, EI measurements are not only simple and rapid but also highly reproducible. 9 In this study, CS is more frequently seen in males, with a male-to-female ratio of 2:1.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Ventriculomegaly in Patients With Craniosynostosis

Liu,

Li,

Zhang

et al. 2023

Journal of Craniofacial Surgery

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“…More importantly, there is currently no unified standard to specify which plane and angle should be used for standardized EI measurements. The comparison of EI results using different planes and angles can lead to differences, which may be due to the different measurement methods rather than changes in the ventricle (Ryska et al, 2021 ). Therefore, standardized and unified imaging planes and angles are very important for the measurement of EI.…”

Section: Discussionmentioning

confidence: 99%

Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review

Zhou

Xia

2022

Front. Aging Neurosci.

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With an ever-growing aging population, the prevalence of normal pressure hydrocephalus (NPH) is increasing. Clinical symptoms of NPH include cognitive impairment, gait disturbance, and urinary incontinence. Surgery can improve symptoms, which leads to the disease's alternative name: treatable dementia. The Evans index (EI), defined as the ratio of the maximal width of the frontal horns to the maximum inner skull diameter, is the most commonly used index to indirectly assess the condition of the ventricles in NPH patients. EI measurement is simple, fast, and does not require any special software; in clinical practice, an EI >0.3 is the criterion for ventricular enlargement. However, EI's measurement methods, threshold setting, correlation with ventricle volume, and even its clinical value has been questioned. Based on the EI, the z-EI and anteroposterior diameter of the lateral ventricle index were derived and are discussed in this review.

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“…Ryska et al reported that the measurements of EI, CA, and other imaging markers will deviate with different angles or scanning sequence parameters, and this deviation often occurs in different centers. Therefore, a more standard and unified definition of the imaging plane or development of a computer-assisted system is warranted in the future [ 24 ]. In addition, a more important reason may be the sample bias caused by the different etiology of NPH in different regions of the world.…”

Section: Discussionmentioning

confidence: 99%

Value of MRI-based semi-quantitative structural neuroimaging in predicting the prognosis of patients with idiopathic normal pressure hydrocephalus after shunt surgery

Chen

Zhang

et al. 2022

Eur Radiol

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Objectives To explore the value of structural neuroimaging in predicting the prognosis of shunt surgery for idiopathic normal-pressure hydrocephalus (iNPH) using two different standard semi-quantitative imaging scales. Methods A total of 47 patients with iNPH who underwent shunt surgery at our hospital between 2018 and 2020 were included in this study. The modified Rankin Scale (mRS) and iNPH grading scale (iNPHGS) were used to evaluate and quantify the clinical symptoms before and after shunt surgery. The disproportionately enlarged subarachnoid space hydrocephalus (DESH) and iNPH Radscale scores were used to evaluate the preoperative MR images. The primary endpoint was improvement in the mRS score a year after surgery, and the secondary endpoint was the iNPHGS after 1 year. The preoperative imaging features of the improved and non-improved groups were compared. Results The rates of the primary and secondary outcomes were 59.6% and 61.7%, respectively, 1 year after surgery. There were no significant differences in preoperative DESH score, iNPH Radscale, Evans’ index (EI), or callosal angle (CA) between the improved and non-improved groups. Significant correlations were observed between the severity of gait disorder and EI and the CA. Conclusions The value of structural neuroimaging in predicting the prognosis of shunt surgery is limited, and screening for shunt surgery candidates should not rely only on preoperative imaging findings. Key Points • Early shunt surgery can significantly improve the clinical symptoms and prognosis of patients with idiopathic normal-pressure hydrocephalus (iNPH). • Structural imaging findings have limited predictiveness for the prognosis of patients with iNPH after shunt surgery. • Patients should not be selected for shunt surgery based on only structural imaging findings.

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Variability of Normal Pressure Hydrocephalus Imaging Biomarkers with Respect to Section Plane Angulation: How Wrong a Radiologist Can Be?

Cited by 6 publications

References 24 publications

Incidence of Ventriculomegaly in Patients With Craniosynostosis

Incidence of Ventriculomegaly in Patients With Craniosynostosis

Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review

Value of MRI-based semi-quantitative structural neuroimaging in predicting the prognosis of patients with idiopathic normal pressure hydrocephalus after shunt surgery

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