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<p>Several radiological signs have been recognized as valuable adjuncts to clinical criteria in the diagnosis of normal pressure hydrocephalus (NPH). Certain magnetic resonance imaging (MRI) findings may also provide information on postoperative outcomes following ventricular shunting. However, the evidence remains inconclusive.&#xa0;We conducted a retrospective cohort study including patients from our institution’s Clinical Care Center for NPH. Preoperative MRI findings—specifically Evan’s Index (EI), callosal angle (CA), disproportionately enlarged subarachnoid space hydrocephalus (DESH), and periventricular white matter hyperintensities (PWMH)—were analyzed in relation to pre- and postoperative clinical status.&#xa0;The median age was 80 years (IQR 75–85), and 68.3% of patients were males. All patients exhibited gait disturbances, 93.3% cognitive impairment, and 83.3% urinary symptoms. Median EI was 0.35 (IQR 0.33–0.37) and median CA was 85.2° (IQR 80–90). DESH was present in 60% of patients, while PWMH were detected in 48.3%. At 1-month follow-up, gait improvement was observed in 66.6%, urinary improvement in 75.6%, and cognitive improvement in 83.0%; sustained at 12 months in 63.8%, 63.8%, and 69.0%, respectively. PWMH correlated with gait improvement (<i>p</i> = 0.04), and DESH with cognitive improvement at 12 months (<i>p</i> = 0.02).&#xa0;DESH and PWMH demonstrated domain-specific prognostic value in idiopathic NPH, whereas EI and CA showed limited predictive utility. Imaging parameters should be interpreted in conjunction with clinical evaluation for outcome prediction.</p>

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Analysis of radiological markers in normal pressure hydrocephalus and their association with postoperative outcomes following shunt procedures

  • 期刊论文

  • 发表日期：

    2026年1月31日

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  • Diego F. Gomez-Amarillo,
  • Ericka Ramirez-Arquez,
  • Juan Daniel Ramirez-Muñoz,
  • Santiago Fuentes-Tapias,
  • Maria P. Vargas-Osorio,
  • Isabella Mejia-Michelsen,
  • Jurgen M. Gonzalez-Jimenez,
  • Alexandra Ramos-Márquez,
  • Sonia Bermudez,
  • Leonardo B. O. Brenner,
  • Raphael Bertani,
  • José de la Hoz-Valle,
  • Juan A. Mejia-Cordovez,
  • Juan F. Ramon,
  • Enrique Jimenez,
  • Edgar G. Ordoñez-Rubiano,
  • Fernando Hakim

摘要

Several radiological signs have been recognized as valuable adjuncts to clinical criteria in the diagnosis of normal pressure hydrocephalus (NPH). Certain magnetic resonance imaging (MRI) findings may also provide information on postoperative outcomes following ventricular shunting. However, the evidence remains inconclusive. We conducted a retrospective cohort study including patients from our institution’s Clinical Care Center for NPH. Preoperative MRI findings—specifically Evan’s Index (EI), callosal angle (CA), disproportionately enlarged subarachnoid space hydrocephalus (DESH), and periventricular white matter hyperintensities (PWMH)—were analyzed in relation to pre- and postoperative clinical status. The median age was 80 years (IQR 75–85), and 68.3% of patients were males. All patients exhibited gait disturbances, 93.3% cognitive impairment, and 83.3% urinary symptoms. Median EI was 0.35 (IQR 0.33–0.37) and median CA was 85.2° (IQR 80–90). DESH was present in 60% of patients, while PWMH were detected in 48.3%. At 1-month follow-up, gait improvement was observed in 66.6%, urinary improvement in 75.6%, and cognitive improvement in 83.0%; sustained at 12 months in 63.8%, 63.8%, and 69.0%, respectively. PWMH correlated with gait improvement (p = 0.04), and DESH with cognitive improvement at 12 months (p = 0.02). DESH and PWMH demonstrated domain-specific prognostic value in idiopathic NPH, whereas EI and CA showed limited predictive utility. Imaging parameters should be interpreted in conjunction with clinical evaluation for outcome prediction.