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Research ArticleAdult Brain

Ventricular Volume Is More Strongly Associated with Clinical Improvement Than the Evans Index after Shunting in Idiopathic Normal Pressure Hydrocephalus

J. Neikter, S. Agerskov, P. Hellström, M. Tullberg, G. Starck, D. Ziegelitz and D. Farahmand
American Journal of Neuroradiology July 2020, 41 (7) 1187-1192; DOI: https://doi.org/10.3174/ajnr.A6620
J. Neikter
aFrom the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
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S. Agerskov
aFrom the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
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P. Hellström
aFrom the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
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M. Tullberg
aFrom the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
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G. Starck
bInstitute of Neuroscience and Physiology, Hydrocephalus Research Unit, and Departments of Radiation Physics (G.S.)
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D. Ziegelitz
cNeuroradiology (D.Z.), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
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D. Farahmand
aFrom the Department of Clinical Neuroscience (J.N., S.A., P.H., M.T., D.F.)
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  • FIG 1.
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    FIG 1.

    Box-and-whisker plot showing the change in ventricular size measured by VV and the EI after shunt treatment in 57 patients with iNPH. The whiskers denote values within the 1.5 interquartile range from the first and third quartiles, and the boxes represent outliers. The P values for the difference between responders (gray) and nonresponders (dark gray) are presented as well as the total (light gray). VV decreased significantly more than the EI for all groups. Responders had a significantly larger VV decrease than nonresponders. There was no difference in the EI between responders and nonresponders.

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    FIG 2.

    Scatterplot illustrating the relation between a postoperative decrease in ventricular volume and shunt response (iNPH scale score) in the participants. Trend lines for a quadratic and piecewise linear function are shown. The shadowed gray areas represent the 95% confidence intervals for the quadratic function, and the bright gray area represents the same interval for the linear function.

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    FIG 3.

    Scatterplot illustrating the linear relation between postoperative decrease in the EI and shunt response (iNPH scale score). The shadowed area represents the 95% confidence intervals for the linear function.

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    FIG 4.

    Ventricle volume segmentation in the ITK-SNAP software showing how susceptibility artifacts from the shunt valve appeared on the postoperative MR imaging.

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    Table 1:

    Demographic data of the patients in the study (n = 57)

    Demographics
    Age (mean) (range) (yr)74 ± 7 (49–91)
    Sex (male/female)42:15
    Preoperative iNPH score (mean) (SD)54 (20)
    Postoperative iNPH score (mean) (SD)66 (22)
    Months from surgery to postoperative follow-up (mean) (range)6 ± 1.6 (3–9)
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    Table 2:

    Preoperative VV and postoperative absolute and relative decreases in VV among 57 patients operated on for iNPH

    Median (Minimum, p25, p75, Maximum)VV vs iNPH Scale Scorea
    Preoperative VV (mL)141.4 (70.8, 133.4, 167.9, 317.8)r = –0.08P = .59
    Postoperative VV (mL)120.8 (4.1, 103.7, 137.9, 309.0)r = –0.28P = .036
    Postoperative absolute decrease in VV (mL)24.1 (−4.0, 15.9, 34.2, 100.1)r = 0.54P < .001
    Postoperative relative decrease in VV (%)16.3 (−2.1, 10.5, 23.1, 96.1)r = 0.56P < .001
    • ↵a Spearman rank correlation test between VV and postoperative change in the iNPH scale score.

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American Journal of Neuroradiology: 41 (7)
American Journal of Neuroradiology
Vol. 41, Issue 7
1 Jul 2020
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J. Neikter, S. Agerskov, P. Hellström, M. Tullberg, G. Starck, D. Ziegelitz, D. Farahmand
Ventricular Volume Is More Strongly Associated with Clinical Improvement Than the Evans Index after Shunting in Idiopathic Normal Pressure Hydrocephalus
American Journal of Neuroradiology Jul 2020, 41 (7) 1187-1192; DOI: 10.3174/ajnr.A6620

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Ventricular Volume Is More Strongly Associated with Clinical Improvement Than the Evans Index after Shunting in Idiopathic Normal Pressure Hydrocephalus
J. Neikter, S. Agerskov, P. Hellström, M. Tullberg, G. Starck, D. Ziegelitz, D. Farahmand
American Journal of Neuroradiology Jul 2020, 41 (7) 1187-1192; DOI: 10.3174/ajnr.A6620
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