Table 19 The use cerebral blood flow for prediction of shunt response in iNPH
Study | Sample size | Radiological methodology | Cutoff level | Imaging technique | Main reported outcomes |
|---|---|---|---|---|---|
Yamada et al. [62] | n = 25 | •Regional CBF of 12 paired segments | •CBF Improvement of < 20% post acetazolamide injection | •SPECT. Following technetium-99 m-L, L-ethylcysteinate dimer injection, the 3DSRT method was used. Baseline CBF then post acetazolamide injection | •Sensitivity of 1.00, specificity of 0.60. TP:22 •TN:2, FP:1, FN:0 |
Ishii et al. [23] | n = 84 | •Changes in regional CBF post injection: anterior-dominant CBF reduction type (A type), posterior-dominant CBF reduction type (P type), and mixed or diffuse CBF reduction type (M type) | •N/A | •SPECT. Imaging at baseline then Following technetium-99 m- injection. The 3DSPP method was used to analyze data | •PPV—A type: 0.83, P type: 0.9, M type 0.84 |
Kazui et al. [27] | n = 100 | •Changes in regional CBF post injection: anterior-dominant CBF reduction type (A type), posterior-dominant CBF reduction type (P type), and mixed or diffuse CBF reduction type (M type) | •N/A | •SPECT. Imaging at baseline then Following technetium-99 m- injection. The 3DSPP method was used to analyze data | •The only statistically significant association was M type—OR: 0.26 (0.07–0.89) p = 0.03 for disappearance of urinary symptoms |
Murakami et al. [39] | n = 24 | Regional CBF | •N/A | •SPECT. Baseline CBF using 3D-SPP, imaging began 20 min after N-isopropyl-p-[123I] iodoamphetamine (IMP) | •Responders have reduced CBF in frontal base and the anterior part of limbic areas (cingulate gyrus). No p-values |
Chen et al. [8] | n = 28 | •CT Xenon CBF measurement. ACT challenge CT for cerebrovascular reactivity capacity (CRC) and CBF | •N/A | •rCBF: for 2 patients: 3 min inhalation protocol (30% xenon). For 26 patients 4 min (26% xenon) wash-in then 5 min washout protocol. Average rCBF: average of 2 measurements each at the anterior, middle and posterior centrum semiovale •CBF post ACT challenge also measured •CRC: scan 15–20 min post ACT challenge of 17 mg/Kg •For both, 4 contiguous slices at basal ganglia level to level of centrum semioval (CSWM) | •rCBF: There was no significant difference between SR (15.3 mL/min per 100 g (SD: 3.7) and SNR (17.9 mL/min per 100 g (SD: 3.8) •Post ACT-challenge: Significant difference between SNR (14.2mLper 100 g/min) vs SR (24.1 mL per 100 g/min) p = 0.008 •CRC: Average CRC could not alone be predictor of SR. Although CRC > 20% at the anterior area of CSWM was significantly different (SNR 1.06% vs SR 1.41%) p = 0.03 •There was strong positive correlation between the NPH scale and average rCBF (p < 0.02), average ACT challenge rCBF (p < 0.05), and CRC (p < 0.03) |
Ziegelitz et al., 2014 [64] | n = 22 | •CBF and Cerebral blood volume (calculated by Ostergaard et al. method). These were mapped onto FLAIR images to find rCBF in 15 anatomical locations of the brain | •basal, medial frontal > 0.798 | •Dynamic susceptibility contrast (DSC) MRI perfusion study using 1.5 T Gyro-scan for a k-space gradient-echo echoplanar imaging (EPI) technique with 0.1 mmol/kg gadolinium-labeled diethylenetriaminepentaacetic acid bolus. ROI were taken from FLAIR images | •There were significant negative correlations between rCBF along the white matter profile (measured at 4 distances from ventricular wall) and improvement in NPH score. (0 mm: -0.448, 2 mm: -0.629, 5 mm: -0.616*7 mm: -0.564). (p < 0.05) •There was a significant negative correlation between rCBF in GM and degree of improvement in the shunt response group. (rho = -0.541, p < 0.05). PVWM rCBF did not significantly correlate with improvement in NPH score •SR had higher rCBF values in the basal medial frontal cortex than SNR (p = 0.019). ROC analysis resulted in AUC < 0.854, using a cutoff of > 0.798 has a sensitivity of 80% and specificity of 100% •TP:12, TN:6, FP: 0, FN: 3 |
Agerskov et al. [3] | n = 20 | •Relative CBF and cerebral blood volume in 6 regions; 3 within upper part of the mesencephalon and 3 located 6 mm caudally in the pons. NB Relative to blood flow to occipital lobe •Mean transit time: CBV/CBF | •N/A | •1.5 T Gyroscan MRI. Dynamic susceptibility contrast using segmented k-space EPI technique was used to assess perfusion with a 5 ml/s bolus of 0.1 mmol/kg Gd-DTPA. Transverse FLAIR sequence was used to draw 6 ROIs across two regions. Perfusion estimates were calculated using arterial input function | •There was no significant relation between pre-operative rCBF and shunt response: •Mesencephalon: SR: 0.86 (IQR 0.77–0.93); SNR: 0.90 (IQR 0.74–1.02) •Pons: SR 0.69 (IQR: 0.61–0.77); SNR: 0.77 (IQR: 0.68–0.94) •There was no significant relation between MTT or CBV with shunt outcome •NB. There was an increase in rCBF in SR group in mesencephalon and pons but in SNR there was a decrease in the mesencephalon |