Open AccessDiagnosis of Normal-Pressure Hydrocephalus: Use of Traditional Measures in the Era of Volumetric MR Imaging
Author(s) -
Nityanand Miskin,
Hersh Patel,
Ana M. Franceschi,
Benjamin AdesAron,
Alexander Le,
Brianna E. Damadian,
Christian L. Stanton,
Yafell Serulle,
James Golomb,
Oded Gonen,
Henry Rusinek,
Ajax E. George
Publication year - 2017
Publication title -
radiology
Language(s) - English
Resource type - Journals
eISSN - 1527-1315
pISSN - 0033-8419
DOI - 10.1148/radiol.2017161216
Subject(s) - medicine , normal pressure hydrocephalus , magnetic resonance imaging , logistic regression , white matter , hydrocephalus , nuclear medicine , radiology , disease , dementia
Purpose To assess the diagnostic performance of the callosal angle (CA) and Evans index (EI) measures and to determine their role versus automated volumetric methods in clinical radiology. Materials and Methods Magnetic resonance (MR) examinations performed before surgery (within 1-5 months of the MR examination) in 36 shunt-responsive patients with normal-pressure hydrocephalus (NPH; mean age, 75 years; age range, 58-87 years; 26 men, 10 women) and MR examinations of age- and sex-matched patients with Alzheimer disease (n = 34) and healthy control volunteers (n = 36) were studied. Three blinded observers independently measured EI and CA for each patient. Volumetric segmentation of global gray matter, white matter, ventricles, and hippocampi was performed by using software. These measures were tested by using multivariable logistic regression models to determine which combination of metrics is most accurate in diagnosis. Results The model that used CA and EI demonstrated 89.6%-93.4% accuracy and average area under the curve of 0.96 in differentiating patients with NPH from patients without NPH (ie, Alzheimer disease and healthy control). The regression model that used volumetric predictors of gray matter and white matter was 94.3% accurate. Conclusion CA and EI may serve as a screening tool to help the radiologist differentiate patients with NPH from patients without NPH, which would allow for designation of patients for further volumetric assessment. © RSNA, 2017.