The Utility of Imaging Parameters in Predicting Long-Term Clinical Improvement After Shunt Surgery in Patients with Idiopathic Normal Pressure Hydrocephalus
The Utility of Imaging Parameters in Predicting Long-Term Clinical Improvement After Shunt Surgery in Patients with Idiopathic Normal Pressure Hydrocephalus
复制标题
DOI：
10.1016/j.wneu.2021.02.108
复制
发表时间：
2021-04-27
影响因子：
2
通讯作者：
Mahajan, Amit
中科院分区：
文献类型：
--
作者：
Subramanian, Harry E.;Fadel, Sandra A.;Mahajan, Amit
-目的：很难预测哪些特发性正常压力脑积水 (iNPH) 患者在分流手术后会得到改善。本研究调查了 iNPH 患者术前影像参数与分流术后长期结局之间的关联。方法：对对大量脑脊液引流有反应并随后接受脑室腹腔分流手术的 iNPH 患者进行回顾。长期患者报告的结果是通过电话访谈获得的。术前计算机断层扫描和/或磁共振成像进行回顾性审查，以确定成像参数与临床结果之间的关联。-结果：最终分析包括 37 名患者。分流手术和电话访谈之间的中位持续时间为 30 个月（范围，12-56 个月）。在没有局灶性脑沟扩张的患者中，分流后的步态改善更常见（95% vs. 71%，P = 0.04），但逻辑回归后并未建立统计学上显着的关系。分流后认知改善的患者术前 Evans 指数较高（平均 0.41 vs. 0.36，P < 0.01），Evans 指数是认知改善的预测因子（比值比 = 1.40，量表为 0.01，P = 0.01）。-结论：较高的 Evans 指数是分流术后长期认知改善的预测因子；然而，没有截止值表明分流候选者的选择具有足够的准确性。所评估的影像学特征均不能预测长期步态或排尿改善。影像学预测分流反应的效用是有限的，并且不能单独使用影像学特征来排除患者进行分流手术。
-OBJECTIVE: It is difficult to predict which patients with idiopathic normal pressure hydrocephalus (iNPH) will improve after shunt surgery. This study investigated the association between preoperative imaging parameters in patients with iNPH and long-term outcome after shunt placement.-METHODS: Patients with iNPH who showed a response to large-volume cerebrospinal fluid drainage and subsequently underwent ventriculoperitoneal shunt surgery were reviewed. Long-term patient-reported outcomes were obtained by telephone interview. Preoperative computed tomography and/or magnetic resonance imaging were retrospectively reviewed to determine associations between imaging parameters and clinical outcome.-RESULTS: The final analysis included 37 patients. The median duration between shunt surgery and telephone interview was 30 months (range, 12e56 months). Gait improvement after shunting was present more often in patients without focally dilated sulci (95% vs. 71%, P = 0.04), but a statistically significant relationship was not established after logistic regression. Patients with cognitive improvement after shunting had a higher preoperative Evans index (mean 0.41 vs. 0.36, P < 0.01), and Evans index was a predictor of cognitive improvement (odds ratio = 1.40, scale of 0.01, P = 0.01).-CONCLUSIONS: Higher Evans index is a predictor of long-term cognitive improvement after shunt placement; however, no cutoff value demonstrates sufficient accuracy for the selection of shunt candidates. None of the evaluated imaging features was predictive of long-term gait or urinary improvement. The utility of imaging to predict a response to shunting is limited, and no imaging feature alone can be used to exclude patients from shunt surgery.