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Table 14 The use of deep white matter hyperintensities for prediction of shunt response in iNPH

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

Study

Sample size

Radiological methodology

Cutoff specification

Image specification

Image plane

Main reported outcomes

Agerskov et al. [2]

n = 168

•Evaluated using ordinal scale graded 0–3

•N/A

•MRI 1.5 T. Trans-axial FLAIR images

•Trans-axial

•0 had grade 0, 46% had grade 1, 37% had grade 2 and 17% had grade 3. There was no difference, in each grade, between SR and SNR

•There were significant (p < 0.05) but weak negative correlations between grade and composite score. (-0.22, -0.21, -0.17 for total, gait, and cognition respectively.)

Narita et al. [41]

n = 103

•According to Fazekas et al. [12]

•N/A

•3D T1-weighted MRI obtained with a Signa 1.5 T MR imaging unit

•Transverse plane

•No significant association with post-surgical improvement reported. (Regression coefficient for total score, gait, cognitive, urinary subsections, TUG and MMSE was − 0.20, − 0.07, 0.01, -0.14, 0.53, 0.10 respectively p > 0.1)

Virhammar et al. [60]

n = 108

•Graded 0–3

•0 = no lesions

•1 = punctate foci

•2 = beginning of confluence of foci

•3 = large confluent areas

•N/A

•T2- FLAIR MRI. (9% of patients on 3 T scanner; 70% on a 1.5 T scanner, 14% on a 1 T scanner and 7% on a 0.5 T scanner

•Transverse plane in center of 3rd ventricle in AP direction

OR between SR and SNR: 0.75 (0.42–1.33), p = 0.33) was statistically insignificant. There was no statistical difference in outcomes between less severe and severe DWMH

Hong et al. [20]

n = 31

•••Measured using Fazekas et al. [12] ordinal scale from 0–3

•N/A

•3.0 Tesla MRI, T2-FLAIR

•Transverse

•There was no significant difference between SR and SNR within each grade (p = 0.054). Grade 0 had 2 SR and 3 SNR, Grade 1 had 15 SR and 6 SNR, Grade 2 had 0 SR and 3 SNR and grade 3 had 0 SR and 1 SNR. Univariate analysis showed an OR: 0.00 (95% CI: 0.974) was insignificant at p = 0.999

  1. Studies included assessing the use of any advanced imaging radiological marker as predictor of shunt responsiveness. SR, shunt response; S-NR, shunt non-response; FLAIR, fluid-attenuated inversion recovery; TUG, timed up and go test; MMSE, mini mental state examination; DWMH, deep white matter hyperintensity; CI, confidence interval