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Table 4 The use of periventricular white matter changes 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

Poca et al

n = 43

•Periventricular lucencies notes in frontal or other locations

•N/A

•CT

•N/A

•22 (51%) patients had periventricular lucencies. 10 (23%) in the frontal horns and 12 (28%) in frontal and other areas

•Patients with lucencies in frontal and other areas showed improvement in NPH scale (one-way ANOVA: 7.56, p = 0.002), the Memory Quotient (one-way ANOVA: 6.21, p = 0.006), and the Orientation part of the WMS (chi-square = 11.41, p = 0.003), compared with no lucencies or just frontal lucencies

McGirt et al. [34]

n = 132

•Not given

•N/A

•CT/MRI

•N/A

•58 (44%) patients had periventricular white matter changes. There was no significant relation between SR and periventricular white matter change. Univariate RR: 1.11 (95% CI: 0.74–1.66)

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% of patients had grade 0, 57% had grade 1, 27% had grades 2 and 17% had grade 3

•There was no difference, in each grade, between SR and SNR

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 − 0.33, − 0.05, − 0.10, − 0.19, 3.19, − 0.25 respectively p > 0.1)

Virhammar et al. [60]

n = 108

•Periventricular hyperintensities along and in contact with the frontal and parietal portions of the lateral ventricles

•Graded 0–2

•0 = normal, including “pencil-thin lining” along the ventricular wall and small caps around the frontal horns

•1 = Increased PVH

•2 = Irregular large symmetric hyperintensities

•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: 0.82 (0.39–1.72), p = 0.6) was statistically insignificant

Hong et al. [20]

n = 31

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

•N/A

•3.0 Tesla MRI scanner was used to gain Axial fluid-attenuated inversion recovery (FLAIR), T2- weighted images

•Transverse

•There was no significant difference between SR and SNR within each grade (p = 0.947). Grade 1 had 10 SR and 7 SNR, Grade 2 had 5 SR and 4 SNR, Grade 3 had 2 SR and 2 SNR

OR 0.600 (0.039–9.156) p = 0.713

  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; WMS, Wechsler Memory Scale; TUG, timed up and go test; FLAIR, fluid-attenuated inversion recovery; ANOVA, analysis of variance; RR, risk ratio