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 reversible cause of dementia characterized by gait disturbance, urinary incontinence, and cognitive decline. Although shunt surgery is effective, selecting appropriate candidates remains challenging. This study aimed to compare the predictive value of preoperative CSF flow MRI and Radscale scores with clinical findings and postoperative shunt response.
Materials and Methods: This retrospective study included patients who underwent shunt surgery for iNPH between 2016 and 2025. Inclusion criteria were: preoperative brain MRI and CSF flow MRI (including peak velocity), and available clinical data before and after surgery. Patients with Radscale >8 or CSF flow peak velocity ≥8 cm/s were considered radiologically positive. Preoperative clinical status and postoperative outcomes were evaluated based on the presence and resolution of urinary incontinence, gait disturbance, and dementia symptoms. Statistical analyses included Chisquare and Kappa statistics (p<0.05 considered significant).
Results: A total of 23 patients (mean age: 55.6 ± 11.1 years) were included. Preoperative symptom rates were: urinary incontinence (n=13), dementia (n=17), gait disturbance (n=21). Postoperative improvement was observed in 92% of incontinence cases, 76% of dementia cases, and 62% of gait disturbances. Among patients with Radscale >8, clinical symptom presence and shunt response were as follows: Urinary incontinence: 7/13 (53.8%) pre-op, 6/12 (50%) improved, Dementia: 11/17 (64.7%) pre-op, 8/13 (61.5%) improved, Gait: 11/21 (52.4%) pre-op, 8/13 (61.5%) improved. For patients with CSF peak velocity ≥8 cm/s: Urinary incontinence: 7/13 (53.8%) pre-op and 7/12 (53.8%) improved, Dementia: 12/17 (70.6%) pre-op, 10/13 (76.9%) improved, Gait: 9/21 (42.9%) pre-op, 7/13 (53.8%) improved.Both imaging methods showed moderate consistency (Kappa = 0.348). CSF flow MRI slightly outperformed Radscale in predicting dementia-related improvement.
Conclusion: Both Radscale and CSF flow MRI are helpful tools in identifying iNPH patients with potential to benefit from shunting. While CSF flow MRI may better correlate with cognitive symptoms and postoperative recovery, neither method showed strong agreement with all clinical outcomes. A multimodal diagnostic approach remains essential.