High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus
High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus
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DOI：
10.3174/ajnr.a4838
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发表时间：
2016-10-01
影响因子：
3.5
通讯作者：
Mori, E.
中科院分区：
文献类型：
--
作者：
Narita, W.;Nishio, Y.;Mori, E.
60例特发性常压脑积水患者在分流术前和术后1年进行了术前脑MRI和临床评价。作者评估了MRI影像学特征，包括Evans指数、高凸性紧密度、侧裂扩张、胼胝体角、皮质沟局灶性扩大、侧脑室顶隆起、深部白色物质和室周高信号。多元线性回归分析表明，术前高凸性的紧密性单独预测的临床症状的改善1年后surgery.Background AND Purpose：虽然神经影像学在特发性正常压力脑积水的诊断中起着重要的作用，其预测价值的分流手术的反应尚未建立。当前研究的目的是确定预测特发性正常压力脑积水分流反应的神经影像学标记物。材料和方法：60名特发性正常压力脑积水患者在分流手术前和分流手术后1年接受了术前脑部MR成像和临床评价。评估的MR成像特征包括Evans指数、高凸度紧密度、侧裂扩张、胼胝体角、皮质沟局灶性扩大、侧脑室顶隆起、深部白色物质和脑室周围高信号。特发性正常压力脑积水分级量表总分被用作主要临床结局指标。我们使用个体症状指标（即，特发性正常压力脑积水分级量表子域评分，如步态、认知和泌尿评分）、计时起身和行走试验和简易精神状态检查作为次要临床结局指标。采用简单线性回归分析方法，探讨术前神经影像学特征与术后临床变化的关系。为了确定一套术前磁共振成像功能，最好地预测手术结果，我们进行了多元线性回归分析，通过使用双向逐步的方法。结果：简单的线性回归分析表明，术前高凸性紧张度，胼胝体角度，和侧裂扩张显着相关的1年的临床症状的变化。多元线性回归分析表明，术前高凸紧度单独预测术后1年的临床症状的改善。结论：高凸紧度是一个神经影像学特征预测分流反应特发性正常压力脑积水。
Sixty patients with idiopathic normal pressure hydrocephalus underwent presurgical brain MR imaging and clinical evaluation before and 1 year after shunt surgery. The authors assessed the MR imaging features including Evans index, high-convexity tightness, Sylvian fissure dilation, callosal angle, focal enlargement of the cortical sulci, bumps in the lateral ventricular roof, and deep white matter and periventricular hyperintensities. Multiple linear regression analyses demonstrated that presurgical high-convexity tightness alone predicted the improvement of the clinical symptoms 1 year after surgery.BACKGROUND AND PURPOSE: Although neuroimaging plays an important role in the diagnosis of idiopathic normal pressure hydrocephalus, its predictive value for response to shunt surgery has not been established. The purpose of the current study was to identify neuroimaging markers that predict the shunt response of idiopathic normal pressure hydrocephalus.MATERIALS AND METHODS: Sixty patients with idiopathic normal pressure hydrocephalus underwent presurgical brain MR imaging and clinical evaluation before and 1 year after shunt surgery. The assessed MR imaging features included the Evans index, high-convexity tightness, Sylvian fissure dilation, callosal angle, focal enlargement of the cortical sulci, bumps in the lateral ventricular roof, and deep white matter and periventricular hyperintensities. The idiopathic normal pressure hydrocephalus grading scale total score was used as a primary clinical outcome measure. We used measures for individual symptoms (ie, the idiopathic normal pressure hydrocephalus grading scale subdomain scores, such as gait, cognitive, and urinary scores), the Timed Up and Go test, and the Mini-Mental State Examination as secondary clinical outcome measures. The relationships between presurgical neuroimaging features and postoperative clinical changes were investigated by using simple linear regression analysis. To identify the set of presurgical MR imaging features that best predict surgical outcomes, we performed multiple linear regression analysis by using a bidirectional stepwise method.RESULTS: Simple linear regression analyses demonstrated that presurgical high-convexity tightness, callosal angle, and Sylvian fissure dilation were significantly associated with the 1-year changes in the clinical symptoms. A multiple linear regression analysis demonstrated that presurgical high-convexity tightness alone predicted the improvement of the clinical symptoms 1 year after surgery.CONCLUSIONS: High-convexity tightness is a neuroimaging feature predictive of shunt response in idiopathic normal pressure hydrocephalus.