Utility of Radiologic Variables to Predict the Result of Lumbar Infusion Test in the Diagnosis of Idiopathic Normal Pressure Hydrocephalus

Otero-Rodríguez, A.; Sousa-Casasnovas, Pablo; Cruz-Terrón, Helena; Arandia-Guzmán, Daniel Angel; García-Martín, Andoni; Pascual-Argente, Daniel; Muñoz-Martín, María Cristina

doi:10.1016/j.wneu.2019.04.009

Cited by 9 publications

(2 citation statements)

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“…One additional eligible study was identified from the bibliographies of articles. 12 After full-text reviews of 17 articles, 7 articles were further excluded for the following reasons: Three articles were not in the field of interest, 14,18,35 and 4 articles had insufficient information for reconstruction of 2 Â 2 tables. 13,15,17,36 Of the 4 articles, 3 articles reported an association between DESH and postsurgical outcome based on correlation and regression analyses.…”

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confidence: 99%

“…6,10,11 Several studies have attempted identifying radiologic markers to predict treatment response in iNPH, including the callosal angle and disproportionately enlarged subarachnoid space hydrocephalus (DESH). [12][13][14][15] DESH refers to a morphologic pattern of communicating hydrocephalus that features uneven distribution of CSF between the superior and inferior subarachnoid spaces. 15 DESH has gained recognition for its prognostic and diagnostic utility in iNPH.…”

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

Park

Suh

et al. 2021

AJNR Am J Neuroradiol

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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...

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