Brain MRI as a predictor of CSF tap test response in patients with idiopathic normal pressure hydrocephalus |
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Authors: | Wei-Ju Lee Shuu-Jiun Wang Li-Chi Hsu Jiing-Feng Lirng Chen-Hao Wu Jong-Ling Fuh |
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Institution: | (1) Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan;(2) National Yang-Ming University School of Medicine, Taipei, Taiwan;(3) Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan;(4) Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan;(5) Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan; |
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Abstract: | In this study, our objective was to identify the characteristic morphological features of brain MRI associated with a positive
cerebrospinal fluid (CSF) tap test in patients with idiopathic normal pressure hydrocephalus (iNPH). Patients diagnosed with
clinical suspected iNPH were evaluated. All patients underwent a mini-mental state examination, a brain MRI, and a CSF tap
test. The severities of clinical symptoms were rated before and after the CSF tap test. Characteristic brain MRI findings
including frontal convexity narrowing, parietal convexity narrowing, upward bowing of the corpus callosum, empty sella, narrowing
of the CSF space at the high convexity, marked dilatation of the Sylvian fissure, and disproportion between narrowing of the
CSF space at the high convexity and dilatation of the Sylvian fissure (“mismatch” sign) on T1-weighted or FLAIR image were
analyzed. Forty-three patients (33 males/ten females, mean age 76.9 ± 6.9 years) with possible iNPH participated in this study.
The presence versus absence of empty sella (52.4 vs. 14.3%, OR 6.6, 95% CI 1.5–29.4, p = 0.02) and “mismatch” sign (45.5 vs. 9.5%, OR 7.9, 95% CI 1.5–42.5, p = 0.02) were associated with positive CSF tap test responses. The sensitivity, specificity, positive predictive value, and
negative predictive value of the presence of either of these two MRI features in the prediction of CSF tap response were 72.7,
81, 80, and 73.9%, respectively. Specific brain MRI features can be used as markers for the identification of potential CSF
tap test responders in iNPH patients. These features may serve as supplemental evidence in the diagnosis of iNPH patients. |
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