A new quantitative method to assess disproportionately enlarged subarachnoid space (DESH) in patients with possible idiopathic normal pressure hydrocephalus: The SILVER index

Benedetto, Nicola; Gambacciani, Carlo; Aquila, Filippo; Carlo, Davide Tiziano Di; Morganti, Riccardo; Perrini, Paolo

doi:10.1016/j.clineuro.2017.04.015

Cited by 20 publications

(17 citation statements)

References 18 publications

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“…Overall, we consider the patient sample representative, and the results reported here are robust. Moreover, our results are in agreement with those of Craven et al 12 ; and in a recent report by Benedetto et al 26 using a CT-based method to assess DESH, there were no differences between patients who improved and those who did not improve after shunt surgery.…”

Section: Discussionsupporting

confidence: 93%

Absence of Disproportionately Enlarged Subarachnoid Space Hydrocephalus, a Sharp Callosal Angle, or Other Morphologic MRI Markers Should Not Be Used to Exclude Patients with Idiopathic Normal Pressure Hydrocephalus from Shunt Surgery

Agerskov

Wallin

Hellström

et al. 2018

AJNR Am J Neuroradiol

101

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BACKGROUND AND PURPOSE: Several studies have evaluated the use of MR imaging markers for the prediction of outcome after shunt surgery in idiopathic normal pressure hydrocephalus with conflicting results. Our aim was to investigate the predictive value of a number of earlier proposed morphologic MR imaging markers in a large group of patients with idiopathic normal pressure hydrocephalus. MATERIALS AND METHODS: One hundred sixty-eight patients (mean age, 70 Ϯ 9.3 years) with idiopathic normal pressure hydrocephalus, subjected to standardized quantification of clinical symptoms before and after shunt surgery, were included in the study. Outcome was calculated using a composite score. Preoperative T1, FLAIR, and flow-sensitive images were analyzed regarding the presence of 13 different morphologic MR imaging markers. RESULTS: The median Evans index was 0.41 (interquartile range, 0.37-0.44). All patients had an aqueductal flow void sign present and white matter hyperintensities. The median callosal angle was 68.8°(interquartile range, 57.7°-80.8°). Dilated Sylvian fissures were found in 69%; focally dilated sulci, in 25%; and widening of the interhemispheric fissure, in 55%. Obliteration of the sulci at the convexity was found in 36%, and 36% of patients were characterized as having disproportionately enlarged subarachnoid space hydrocephalus. Sixty-eight percent of patients improved after surgery. None of the investigated MR imaging markers were significant predictors of improvement after shunt surgery. CONCLUSIONS: Disproportionately enlarged subarachnoid space hydrocephalus, a small callosal angle, and the other MR imaging markers evaluated in this study should not be used to exclude patients from shunt surgery. These markers, though they may be indicative of idiopathic normal pressure hydrocephalus, do not seem to be a part of the mechanisms connected to the reversibility of the syndrome. ABBREVIATIONS: DESH ϭ disproportionately enlarged subarachnoid space hydrocephalus; EI ϭ Evans index; iNPH ϭ idiopathic normal pressure hydrocephalus

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Section: Discussionsupporting

confidence: 93%

Absence of Disproportionately Enlarged Subarachnoid Space Hydrocephalus, a Sharp Callosal Angle, or Other Morphologic MRI Markers Should Not Be Used to Exclude Patients with Idiopathic Normal Pressure Hydrocephalus from Shunt Surgery

Agerskov

Wallin

Hellström

et al. 2018

AJNR Am J Neuroradiol

101

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“…67 Volumetric tissue segmentation could be a more objective and automatized method to measure CSF content versus atrophy, as with the "Silver Index." 66,68,69 Wholebrain volumetry may be required as a minimal standard in future patients to assess whether changes in the brain parenchyma reflect true atrophy or the pseudoatrophy of DESH. 13 Dedicated imaging techniques, such as sagittal FIESTA-C (fast imaging employing steady-state acquisition-C), would be useful to better detect aqueductal stenosis in patients with longstanding overt ventriculomegaly in adults.…”

Section: Scales For Measurement Of Symptom Severity and Treatment Outmentioning

confidence: 99%

Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

et al. 2020

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A BS TRACT: Idiopathic normal pressure hydrocephalus is considered common but remains underinvestigated. There are no uniformly accepted diagnostic criteria and therapeutic guidelines. We summarize the accumulated evidence regarding the definition, pathophysiology, diagnosis, and treatment of idiopathic normal pressure hydrocephalus, highlighting the many gaps and controversies, including diagnostic challenges, the frequent association with neurodegeneration and vascular disease, and the many unknowns regarding patient selection and outcome predictors. A roadmap to fill these gaps and solve the controversies around this condition is also proposed. More evidence is required with respect to diagnostic criteria, the value of ancillary testing, prospective population-based studies and novel trial designs. Furthermore, a need exists to develop new advanced options in shunt technology.

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“…Evans’ index[17]Callosal angles[18]Magnetic resonance elastography[19]Glymphatic MRI[20]Hyperdynamic CSF motion[21]The SILVER Index: Disproportionately enlarged subarachnoid space[22]Reversed aqueductal CSF net flow[23]MRI water apparent diffusion coefficient[24]Arterial spin labeling perfusion MRI[25]Computed tomography perfusion[26]Computerized volumetric assessment of the intracranial CSF distribution[27]Brain to ventricle ratios at the anterior and posterior commissure levels and three-dimensional (3D) volumetric convexity cistern to ventricle ratios[28]High-field 3D-MRI study of subarachnoid space. [29]…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Current updates on idiopathic normal pressure hydrocephalus

Liew

Takagi²,

Kato

et al. 2019

Asian J Neurosurg

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Idiopathic normal pressure hydrocephalus (iNPH) is one of the neurodegenerative diseases which can be treated surgically with favorable outcome. The gait disturbance, cognitive, and urinary symptoms are known as the clinical triad of iNPH. In this review, we have addressed the comorbidities, differential diagnoses, clinical presentations, and pathology of iNPH. We have also summarized the imaging studies and clinical procedures used for the diagnosis of iNPH. The treatment modality, outcomes, and prognosis were also discussed.

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A new quantitative method to assess disproportionately enlarged subarachnoid space (DESH) in patients with possible idiopathic normal pressure hydrocephalus: The SILVER index

Cited by 20 publications

References 18 publications

Absence of Disproportionately Enlarged Subarachnoid Space Hydrocephalus, a Sharp Callosal Angle, or Other Morphologic MRI Markers Should Not Be Used to Exclude Patients with Idiopathic Normal Pressure Hydrocephalus from Shunt Surgery

Absence of Disproportionately Enlarged Subarachnoid Space Hydrocephalus, a Sharp Callosal Angle, or Other Morphologic MRI Markers Should Not Be Used to Exclude Patients with Idiopathic Normal Pressure Hydrocephalus from Shunt Surgery

Gaps, Controversies, and Proposed Roadmap for Research in Normal Pressure Hydrocephalus

Current updates on idiopathic normal pressure hydrocephalus

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