Akademik Veri Yönetim Sistemi
48th ESNR Annual Meeting & 15th Asian-Oceanian Congress of Neuroradiology and Head and Neck Radiology & 34th Annual Meeting of the Turkish Society of Neuroradiology, Türkiye, 17 - 21 Eylül 2025, (Özet Bildiri)
Purpose: Idiopathic normal pressure hydrocephalus (iNPH) is a subtype of communicating hydrocephalus seen in the elderly, characterized by gait disturbance, cognitive impairment, and urinary incontinence. Differentiating iNPH from other neurodegenerative disorders such as Alzheimer’s disease and Parkinsonian syndromes remains difficult. In recent years, noninvasive imaging tools like the iNPH Radscale and phase-contrast MRI-based cerebrospinal fluid (CSF) flow analysis have gained importance. However, limited studies have directly compared these two modalities. This study aims to evaluate the relationship between structural imaging parameters scored using the iNPH Radscale and CSF flow dynamics obtained via phase-contrast MRI in patients with suspected iNPH.
Materials and Methods: This retrospective study included patients who underwent both cranial MRI and CSF flow MRI for suspected iNPH between 2014 and 2017. The iNPH Radscale evaluated seven features: Evans’ index, sulcal narrowing, Sylvian fissure dilation, focally enlarged sulci, temporal horn width, callosal angle, and periventricular hyperintensities. CSF flow parameters—stroke volume, peak systolic velocity, and mean velocity—were measured at the aqueductal level. The relationship between structural and flow parameters was analyzed using Spearman’s correlation, Chi-square, and Kappa statistics, with p<0.05 considered significant.
Results: Thirty-three patients (mean age: 71.8 ± 10.1 years; 24.2% female) were included. Mean peak CSF flow velocity was 7.99 ± 3.70 cm/s. Using a threshold of 8 cm/s, 15 patients (45.5%) had elevated flow. The median Radscale score was 6 (range: 5–8), with 22 patients (66.7%) scoring above the diagnostic threshold. Both tests indicated iNPH in 9 patients (60%). The agreement between the two tests was low (Kappa = 0.125), and no significant correlation was found between other individual parameters.
Conclusion: There was limited agreement between the iNPH Radscale and CSF flow MRI findings, as well as between each method and clinical diagnostic standards such as the tap test or shunt response. These results suggest that while both imaging modalities are commonly used, they may reflect different aspects of iNPH and should not be used interchangeably. Further studies are needed to improve diagnostic accuracy through combined or novel imaging approaches.