1. Quantitative imaging features predict spinal tap response in normal pressure hydrocephalus
- Author
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Henry Rusinek, Benjamin Ades-Aron, Eyal Lotan, James Golomb, Brianna E. Damadian, Ajax E. George, Ning Lu, and Megan Griffin
- Subjects
Male ,medicine.medical_specialty ,Spinal tap ,Neuroimaging ,Logistic regression ,Spinal Puncture ,Lumbar ,Normal pressure hydrocephalus ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neuroradiology ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Lumbar puncture ,medicine.disease ,Gait ,Magnetic Resonance Imaging ,film.actor ,Hydrocephalus, Normal Pressure ,Hydrocephalus ,film ,Cardiology ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Gait improvement following high-volume lumbar puncture (HVLP) and continuous lumbar drain (cLD) is widely used to predict shunt response in patients with suspected normal pressure hydrocephalus (NPH). Here, we investigate differences in MRI volumetric and traditional measures between HVLP/cLD responders and non-responders to identify imaging features that may help predict HVLP/cLD response. Eighty-two patients with suspected NPH were studied retrospectively. Gait testing was performed before and immediately/24 h/72 h after HVLP/cLD. A positive response was defined as improvement in gait post-procedure. Thirty-six responders (26 men; mean age 79.3 ± 6.3) and 46 non-responders (25 men; mean age 77.2 ± 6.1) underwent pre-procedure brain MRI including a 3D T1-weighted sequence. Subcortical regional volumes were segmented using FreeSurfer. After normalizing for total intracranial volume, two-way type III ANCOVA test and chi-square test were used to characterize statistical group differences. Evans’ index, callosal angle (CA), and disproportionately enlarged subarachnoid space hydrocephalus were assessed. Multivariable logistic regression models were tested using Akaike information criterion to determine which combination of metrics most accurately predicts HVLP/cLD response. Responders and non-responders demonstrated no differences in total ventricular and white/gray matter volumes. CA (men only) and third and fourth ventricular volumes were smaller; and hippocampal volume was larger in responders (p
- Published
- 2021