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Table 2 The use of Evan’s Index on MRI and CT 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

Narita et al. [41]

n = 103

•Ratio between max diameter of the frontal horns of lateral ventricles to the max skull inner diameter

N/A

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

•Transverse plane

•No significant association between Evan’s Index and post-surgical improvement reported. (Regression coefficient for total score, gait, cognitive, urinary subsections, TUG and MMSE was 7.34, 1.00, 0.97, 5.37, 60.96, 9.22 respectively p > 0.1)

Virhammar et al., 2014[60]

n = 108

•Ratio between max diameter of the frontal horns of lateral ventricles to the max skull inner diameter

N/A

•T2 Flair, T1-weighted 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

OR between SR and SNR: 1.57 (0.97–2.52), p = 0.064)

Hong et al. [20]

n = 31

•Ratio between the max diameter of frontal horns of the lateral ventricles and the max inner diameter of the skull

N/A

•3.0 Tesla MRI scanner was used to gain axial FLAIR, T2- weighted images, T1-weighted images, and coronal T1-weighted images

•Transverse plane

•There was no significant difference in Evan’s Index between SR and SNR. SR had mean Evan’s Index of 0.37 ± 0.04 while SNR had mean Evan’s Index 0.37 ± 0.03 (p = 0.77)

Agerskov et al. [2]

n = 168

•Ratio between max diameter of frontal horns and the max inner skull diameter

N/A

•MRI 1.5 T

•Trans-axial T1-weighted images

•Transverse plane in slice above the foramen of Monro

•All patients had Evan’s Index > 0.3

•There was no difference in Evan’s Index findings between SR (median 0.4) and SNR (median 0.39) [p > 0.05] and it could not be used to predict SR in multivariate logistical analysis

•Its non-significant correlation coefficient with the composite score was -0.09

Wu et al. [61]

n = 41

•Not given

N/A

•High-resolution T1-weighted MRI

•Not given

•The model predictions using Evan’s Index alone with co-variates mentioned in methodology showed a low correlation with the ground truth (r = 0.48 for the Tinetti and r = 0.80 for MMSE)

•When the co-variates were removed from the input, the prediction accuracy was 0.42 and 0.46 for the Tinetti and MMSE respectively

  1. Studies included assessing the use of any MRI or CT Evan’s Index as predictor of shunt responsiveness. SR, shunt response; S-NR, shunt non-response; FLAIR, Fluid-attenuated inversion recovery; MMSE, mini mental state examination; TUG, timed up and go test