High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus

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Fig 1.
Visual rating scales for neuroimaging features in iNPH. A, High-convexity tightness: 0, dilated; 1, normal; 2, mildly tight; 3, severely tight. B, Sylvian fissure dilation: 0, narrowed; 1, normal; 2, mildly dilated; 3, severely dilated. C, Focal dilation of the sulci (indicated by the arrows). D, Bumps in the lateral ventricular roof (indicated by the arrows). E, Callosal angle.

Table 1:

Presurgical clinical characteristics of patients (n = 60)^{^a}

Note:—LP indicates lumboperitoneal.
↵a Age, education, and the duration of symptoms are indicated as the means (SDs). The other variables are indicated as the number of patients (%).
↵b Each symptom was regarded as positive when the corresponding score of the iNPH grading scale was ≥2.

Table 2:

Changes in the clinical symptoms at 1 year^{^a}

	Presurgical Score		Postsurgical Score		Difference		Postsurgical Changes (No.) (%)
	No.	Median (IQR)	No.	Median (IQR)	Median (IQR)	P Value^{^b}	Improved	Stable	Deteriorated
iNPHGS total [12]	60	6.0 (5.0–8.0)	60	5.0 (3.0–6.0)	1.0 (0.5–3.0)	<.001	45 (75)	10 (17)	5 (8)
iNPHGS gait [4]	60	2.0 (2.0–3.0)	60	2.0 (1.0–3.0)	1.0 (0.5–1.0)	<.001	32 (53)	24 (40)	4 (7)
iNPHGS cognitive [4]	60	2.0 (2.0–3.0)	60	2.0 (1.3–3.0)	0 (0–1.0)	.001	20 (33)	36 (60)	4 (7)
iNPHGS urinary [4]	60	2.5 (1.0–3.0)	60	1.0 (0–1.0)	0 (0–1.0)	<.001	29 (48)	24 (40)	7 (12)
TUG	55	15.1 (11.0–20.6)	53	11.5 (9.2–14.5)	2.5 (0.8–4.2)	<.001	35 (66)	13 (25)	5 (9)
MMSE [30]	60	22.0 (20.0–24.8)	59	23.0 (21.0–27.0)	1 (−1–3.0)	.014	19 (32)	32 (54)	8 (14)

Note:—IQR indicates interquartile range.
↵a Clinical improvement and deterioration were defined as ≥1-point improvement or deterioration on the iNPHGS, ≥10% reduction or increase in TUG time, and ≥3 points gained or lost on the MMSE. The numbers in square brackets refer to the maximum scores for the tests.
↵b Wilcoxon signed rank test for pre- and postsurgery comparisons.

Table 3:

Presurgical neuroimaging features

	Score^{^a} (Median [IQR])	Reliability (κ_w)
High-convexity tightness	2.5 (2.0–3.0)	0.68
Sylvian fissure dilation	3.0 (2.5–3.0)	0.50
Focal enlargement of cortical sulci	0.5 (0–1.0)	0.27
Bumps in the lateral ventricular roof	1.0 (0.1–1.0)	0.66
DWMHs^{^b}	2.0 (2.0–3.0)	0.71
PVHs^{^b}	2.5 (2.0–3.0)	0.64
Evans index	0.32 (0.31–0.36	–
Callosal angle	79.7 (65.5–100.1)	–

Note:—IQR indicates interquartile range; κ_w, linear weighted κ coefficient.
↵a The visual rating scores indicate the mean scores of the 2 raters.
↵b The DWMHs and PVHs were obtained from 44 patients.

Table 4:

Results of simple linear regression analysis for presurgical neuroimaging features associated with surgical outcome: 1-year changes

Neuroimaging Findings	iNPHGS				TUG	MMSE
Neuroimaging Findings	Total	Gait	Cognitive	Urinary	TUG	MMSE
Evans Index	7.34	1.00	0.97	5.37	60.96	9.22
Callosal angle	−0.02	−0.01	−0.01	−0.01	−0.12	−0.04^{^a}
High-convexity tightness	1.23^{^b}	0.59^{^b}	0.22	0.42	−3.17	2.56^{^b}
Sylvian fissure dilation	1.03	0.59^{^a}	−0.09	0.53	−2.65	1.00
Focal enlargement of cortical sulci	0.71	0.19	0.00	0.53	−2.25	1.19
Bumps in the lateral ventricle	0.47	0.31	0.11	0.05	2.20	1.20
DWMHs	−0.20	−0.07	0.01	−0.14	0.53	0.10
PVHs	−0.33	−0.05	−0.10	−0.19	3.19	−0.25