Prognostic Utility of Disproportionately Enlarged Subarachnoid Space Hydrocephalus in Idiopathic Normal Pressure Hydrocephalus Treated with Ventriculoperitoneal Shunt Surgery: A Systematic Review and Meta-analysis

Abstract

BACKGROUND: Disproportionately enlarged subarachnoid space hydrocephalus is a specific radiologic marker for idiopathic normal pressure hydrocephalus. However, controversy exists regarding the prognostic utility of disproportionately enlarged subarachnoid space hydrocephalus. PURPOSE: Our aim was to evaluate the prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and its predictive utility regarding prognosis in patients treated with ventriculoperitoneal shunt surgery.DATA SOURCES: We used MEDLINE and EMBASE databases. STUDY SELECTION:We searched for studies that reported the prevalence or the diagnostic performance of disproportionately enlarged subarachnoid space hydrocephalus in predicting treatment response. DATA ANALYSIS:The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus was obtained. Pooled sensitivity, specificity, and area under the curve of disproportionately enlarged subarachnoid space hydrocephalus to predict treatment response were obtained. Subgroup and sensitivity analyses were performed to explain heterogeneity among the studies.DATA SYNTHESIS: Ten articles with 812 patients were included. The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus was 44% (95% CI, 34%-54%). The pooled prevalence of disproportionately enlarged subarachnoid space hydrocephalus was higher in the studies using the second edition of the Japanese Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus compared with the studies using the international guidelines without statistical significance (52% versus 43%, P ¼ .38). The pooled sensitivity and specificity of disproportionately enlarged subarachnoid space hydrocephalus for prediction of treatment response were 59% (95% CI, 38%-77%) and 66% (95% CI, 57%-74%), respectively, with an area under the curve of 0.67 (95% CI, 0.63-0.71). LIMITATIONS:The lack of an established method for assessing disproportionately enlarged subarachnoid space hydrocephalus using brain MR imaging served as an important cause of the heterogeneity. CONCLUSIONS:Our meta-analysis demonstrated a relatively low prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and a poor diagnostic performance for treatment response.ABBREVIATIONS: DESH ¼ disproportionately enlarged subarachnoid space hydrocephalus; HSROC ¼ hierarchical summary receiver operating characteristic; iNPH ¼ idiopathic normal pressure hydrocephalus; NPV ¼ negative predictive value; PPV ¼ positive predictive value; VP ¼ ventriculoperitoneal I diopathic normal pressure hydrocephalus (iNPH) is a potentially reversible disease characterized by the triad of gait disturbance, dementia, and urinary incontinence. 1,2 Currently, the only effective treatment for iNPH is CSF shunt surgery, with ventriculoperitoneal (VP) shunt surgery being the most commonly performed. 3 However, the procedure is invas...

Radiological predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

“…Two systematic reviews [ 43 , 44 ] with meta-analyses have been published recently evaluating Evan’s index, callosal angle, and DESH that both performed a quantitative analysis comparing diagnostic effectiveness of these radiological markers. Both reviews found that callosal angle outperformed Evan’s index as predictor of shunt responsiveness in terms of diagnostic accuracy and intra-observer agreement.…”

Value of MRI-based semi-quantitative structural neuroimaging in predicting the prognosis of patients with idiopathic normal pressure hydrocephalus after shunt surgery

“…However, the iNPH sub-population with typical imaging features is only one subgroup. The rate of detection of DESH is only approximately 30–50%, and its ability to diagnose treatment response is poor [ 12 , 16 , 27 ]. This can lead to selection bias and exclude iNPH patients with atypical imaging findings from the operation schedule.…”

Brain MRI-Based Artificial Intelligence Software in Patients with Neurodegenerative Diseases: Current Status

“…10개의 논문을 기반으로한 메타분석에서 뇌량 각도의 정상압 수두증 진단능은 민감도 91%, 특이도 93%로 비교적 높게 보고되었다( 46 ). 하지만 다른 10개의 논문을 기반으로한 메타분석에서 DESH 소견은 특발성 정상압 수두증에서 44%에서만 보였다( 47 ). 다른 연구에서도 DESH의 민감도가 50% 미만으로 높지 않으며 일치도도 높지 않다는 한계가 지적되었다( 48 ).…”