The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus

Wikkelsø, Carsten; Hellström, Per; Klinge, Petra M.; Tans, J. T. J.

doi:10.1136/jnnp-2012-303314

Cited by 179 publications

(126 citation statements)

References 47 publications

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“…These reasons would mainly complicate iNPH diagnosis only by radiologic findings, and we emphasize that the CSF tap test is important for the diagnosis of iNPH, though the CSF tap test has high specificity (73-100%), its sensitivity is low (26 -61%) for diagnosing shunt-responsive iNPH. 7,21,22 The other limitation was that the signal-intensity-based CSF segmentation method based on the T2-weighted 3D-SPACE sequence had not yet been used in the field of neuroradiology, compared with the atlas-based automatic segmentation method. However, this simple segmentation method by using high-contrast CSF on a T2-weighted sequence will spread throughout the field of neuroradiology with the progression of high-field MR imaging scanners.…”

Section: Discussionmentioning

confidence: 99%

Optimal Diagnostic Indices for Idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space

Yamada

Ishikawa

Yamamoto

2015

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Optimal Diagnostic Indices for Idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space

Yamada

Ishikawa

Yamamoto

2015

AJNR Am J Neuroradiol

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“…6 Clinical improvement after the CSF removal is considered a positive response, with high positive predictive value for a good outcome after shunt surgery. 7 Previous studies have tried to estimate the change in CBF after a CSF TT using inhalation or injection of xenon-133, single photon emission computed tomography, and dynamic susceptibility contrast magnetic resonance imaging (MRI). Increase in CBF after CSF removal has been reported in some of these studies, but the results have not been uniform.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Normal Pressure Hydrocephalus: Cerebral Perfusion Measured with pCASL before and Repeatedly after CSF Removal

Virhammar

Laurell

Ahlgren

et al. 2014

J Cereb Blood Flow Metab

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Pseudo-continuous arterial spin labeling (pCASL) measurements were performed in 20 patients with idiopathic normal pressure hydrocephalus (iNPH) to investigate whether cerebral blood flow (CBF) increases during the first 24 hours after a cerebrospinal fluid tap test (CSF TT). Five pCASL magnetic resonance imaging (MRI) scans were performed. Two scans were performed before removal of 40 mL CSF, and the other three at 30 minutes, 4 hours, and 24 hours, respectively after the CSF TT. Thirteen different regions of interest (ROIs) were manually drawn on coregistered MR images. In patients with increased CBF in lateral and frontal white matter after the CSF TT, gait function improved more than it did in patients with decreased CBF in these regions. However, in the whole sample, there was no significant increase in CBF after CSF removal compared with baseline investigations. The repeatability of CBF measurements at baseline was high, with intraclass correlation coefficients of 0.60 to 0.90 for different ROIs, but the median regional variability was in the range of 5% to 17%. Our results indicate that CBF in white matter close to the lateral ventricles plays a role in the reversibility of symptoms after CSF removal in patients with iNPH.

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“…13,19,22,23 In the present study, multiple regression analysis disclosed a relation between preoperative MMSE, cognitive change after ELD, and the outcome after shunt therapy. Patients with an MMSE below 21 and/ or worsening of cognitive function after ELD should be regarded as high risk for nonresponse to shunt therapy, especially when ROut measurements show pathological values above the cutoff of 14 mm Hg/ml/min.…”

Section: Discussionmentioning

confidence: 86%

“…Therefore, LIFT is not an ideal test to exclude patients from treatment, which is in concordance with the results of a recent multicenter trial. 23 The LIFT false-positive patients, without response to shunt therapy but with intolerance to CSF infusion, constitute a group who requires further investigation for hydrocephalic pathophysiology and possible treatment options. 18 In accordance, ROut values did not show a linear correlation to ∆Kiefer (R 2 = 0.03) (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Idiopathic normal pressure hydrocephalus: diagnostic and predictive value of clinical testing, lumbar drainage, and CSF dynamics

Mahr¹,

Dengl²,

Nestler³

et al. 2016

JNS

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591CliNiCal artiCle J Neurosurg 125:591-597, 2016 I dIopathIc normal pressure hydrocephalus (iNPH) has been a challenging entity for the past 50 years, since its first description by Hakim.21 Despite extensive research, its pathophysiological basis and pathogenesis remain matters of ongoing debate. Due to the uncertainty in diagnostic measures, several algorithms, diagnostic tools, and scoring systems have been proposed. A recent multicenter trial based the decision for surgical therapy on clinical signs and symptoms only, dividing cases into questionable and typical iNPH.23 Given the multitude of noninvasive and invasive measures to select symptomatic patients for hydrocephalus therapy, a prospective analysis of diagnostic and predictive parameters and their individual contributions within the diagnostic algorithm was warranted. Patients and MethodsPatients with suspicious clinical and MRI signs for iNPH were examined in a prospective study. Local ethics committee approval was obtained.abbreviatioNs AMP Q = ICP amplitude quotient; ELD = external lumbar drainage; ETV = endoscopic third ventriculostomy; ICP = intracranial pressure; iNPH = idiopathic normal pressure hydrocephalus; LIFT = lumbar infusion test; MMSE = Mini-Mental State Examination; mRS = modified Rankin Scale; OVM = overnight ICP monitoring; RAP = correlation coefficient between pulse amplitude and ICP; ROC = receiver operating characteristic; ROut = resistance to outflow of CSF; SLHS = Stein and Langfitt Hydrocephalus Score; VP = ventriculoperitoneal; ∆Kiefer = change in Kiefer score. obJeCtive The aim of the study was to analyze the diagnostic and predictive values of clinical tests, CSF dynamics, and intracranial pulsatility tests, compared with external lumbar drainage (ELD), for shunt response in patients with idiopathic normal pressure hydrocephalus (iNPH). Methods Sixty-eight consecutive patients with suspected iNPH were prospectively evaluated. Preoperative assessment included clinical tests, overnight intracranial pressure (ICP) monitoring, lumbar infusion test (LIFT), and ELD for 24-72 hours. Simple and multiple linear regression analyses were conducted to identify predictive parameters concerning the outcome after shunt therapy. results Positive response to ELD correctly predicted improvement after CSF diversion in 87.9% of the patients. A Mini-Mental State Examination (MMSE) value below 21 was associated with nonresponse after shunt insertion (specificity 93%, sensitivity 67%). Resistance to outflow of CSF (ROut) > 12 mm Hg/ml/min was false negative in 21% of patients. Intracranial pulsatility parameters yielded different results in various parameters (correlation coefficient between pulse amplitude and ICP, slow wave amplitude, and mean ICP) but did not correlate to outcome. In multiple linear regression analysis, a calculation of presurgical MMSE versus the value after ELD, ROut, and ICP amplitude quotient during LIFT was significantly associated with outcome (p = 0.04). CoNClusioNs Despite a multitude of invasive tests, presurgical cl...

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The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus

Abstract: The study has been registered at clinicaltrials.gov, identifier NCT00874198.

Cited by 179 publications

References 47 publications

Optimal Diagnostic Indices for Idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space

Optimal Diagnostic Indices for Idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space

Idiopathic Normal Pressure Hydrocephalus: Cerebral Perfusion Measured with pCASL before and Repeatedly after CSF Removal

Idiopathic normal pressure hydrocephalus: diagnostic and predictive value of clinical testing, lumbar drainage, and CSF dynamics

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