Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism
Abstract Background Vascular dementia (VaD) and atypical parkinsonism often present with symptoms that can resemble idiopathic normal pressure hydrocephalus (iNPH) and enlarged cerebral ventricles, and can be challenging differential diagnoses. The aim was to investigate frequencies of imaging featu...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | Fluids and Barriers of the CNS |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12987-021-00270-3 |
| _version_ | 1831548528035364864 |
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| author | David Fällmar Oliver Andersson Lena Kilander Malin Löwenmark Dag Nyholm Johan Virhammar |
| author_facet | David Fällmar Oliver Andersson Lena Kilander Malin Löwenmark Dag Nyholm Johan Virhammar |
| author_sort | David Fällmar |
| collection | DOAJ |
| description | Abstract Background Vascular dementia (VaD) and atypical parkinsonism often present with symptoms that can resemble idiopathic normal pressure hydrocephalus (iNPH) and enlarged cerebral ventricles, and can be challenging differential diagnoses. The aim was to investigate frequencies of imaging features usually associated with iNPH and their radiological diagnostic accuracy in a sample containing the relevant differential diagnoses VaD, progressive supranuclear palsy (PSP), multiple system atrophy parkinsonian type (MSA-P), and healthy controls. Methods Nine morphological imaging features usually associated with iNPH were retrospectively investigated in MR images of 55 patients with shunt-responsive iNPH, 32 patients with VaD, 30 patients with PSP, 27 patients with MSA-P, and 39 age-matched healthy controls. Logistic regression and receiver operating characteristic curves were used to assess diagnostic accuracy, sensitivity, and specificity for each imaging finding. Results In a logistic regression model using iNPH diagnosis as a dependent variable, the following imaging features contributed significantly to the model: callosal angle (OR = 0.95 (0.92–0.99), p = 0.012), Evans’ index * 100 (OR = 1.51 (1.23–1.86), p < 0.001), enlarged Sylvian fissures (OR = 6.01 (1.42–25.40), p = 0.015), and focally enlarged sulci (OR = 10.18 (1.89–55.02), p = 0.007). Imaging features with 95% specificity for iNPH were: callosal angle ≤ 71°, temporal horns ≥ 7 mm, Evans’ index ≥ 0.37, iNPH Radscale ≥ 9, and presence of DESH, bilateral ventricular roof bulgings or focally enlarged sulci. A simplified version of the iNPH Radscale with only four features resulted in equally high diagnostic accuracy as the original iNPH Radscale. Conclusions There is a notable overlap between some of the commonly used imaging markers regarding iNPH, VaD and atypical parkinsonism, such as PSP. However, this study shows that the specificity of imaging markers usually associated with iNPH was high even when comparing with these challenging differential diagnoses. The callosal angle was the single imaging feature with highest diagnostic accuracy to discriminate iNPH from its mimics. A simplified rating scale using only a few selected features could be used with retained specificity. |
| first_indexed | 2024-12-17T02:21:15Z |
| format | Article |
| id | doaj.art-c37d2574e4cd488e82292faa6494bc17 |
| institution | Directory Open Access Journal |
| issn | 2045-8118 |
| language | English |
| last_indexed | 2024-12-17T02:21:15Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Fluids and Barriers of the CNS |
| spelling | doaj.art-c37d2574e4cd488e82292faa6494bc172022-12-21T22:07:15ZengBMCFluids and Barriers of the CNS2045-81182021-07-0118111010.1186/s12987-021-00270-3Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonismDavid Fällmar0Oliver Andersson1Lena Kilander2Malin Löwenmark3Dag Nyholm4Johan Virhammar5Department of Surgical Sciences, Radiology, Uppsala UniversityDepartment of Neuroscience, Neurology, Uppsala UniversityDepartment of Public Health and Caring Sciences, Geriatrics, Uppsala UniversityDepartment of Public Health and Caring Sciences, Geriatrics, Uppsala UniversityDepartment of Neuroscience, Neurology, Uppsala UniversityDepartment of Neuroscience, Neurology, Uppsala UniversityAbstract Background Vascular dementia (VaD) and atypical parkinsonism often present with symptoms that can resemble idiopathic normal pressure hydrocephalus (iNPH) and enlarged cerebral ventricles, and can be challenging differential diagnoses. The aim was to investigate frequencies of imaging features usually associated with iNPH and their radiological diagnostic accuracy in a sample containing the relevant differential diagnoses VaD, progressive supranuclear palsy (PSP), multiple system atrophy parkinsonian type (MSA-P), and healthy controls. Methods Nine morphological imaging features usually associated with iNPH were retrospectively investigated in MR images of 55 patients with shunt-responsive iNPH, 32 patients with VaD, 30 patients with PSP, 27 patients with MSA-P, and 39 age-matched healthy controls. Logistic regression and receiver operating characteristic curves were used to assess diagnostic accuracy, sensitivity, and specificity for each imaging finding. Results In a logistic regression model using iNPH diagnosis as a dependent variable, the following imaging features contributed significantly to the model: callosal angle (OR = 0.95 (0.92–0.99), p = 0.012), Evans’ index * 100 (OR = 1.51 (1.23–1.86), p < 0.001), enlarged Sylvian fissures (OR = 6.01 (1.42–25.40), p = 0.015), and focally enlarged sulci (OR = 10.18 (1.89–55.02), p = 0.007). Imaging features with 95% specificity for iNPH were: callosal angle ≤ 71°, temporal horns ≥ 7 mm, Evans’ index ≥ 0.37, iNPH Radscale ≥ 9, and presence of DESH, bilateral ventricular roof bulgings or focally enlarged sulci. A simplified version of the iNPH Radscale with only four features resulted in equally high diagnostic accuracy as the original iNPH Radscale. Conclusions There is a notable overlap between some of the commonly used imaging markers regarding iNPH, VaD and atypical parkinsonism, such as PSP. However, this study shows that the specificity of imaging markers usually associated with iNPH was high even when comparing with these challenging differential diagnoses. The callosal angle was the single imaging feature with highest diagnostic accuracy to discriminate iNPH from its mimics. A simplified rating scale using only a few selected features could be used with retained specificity.https://doi.org/10.1186/s12987-021-00270-3Normal pressure hydrocephalusDifferential diagnosticsImaging featuresVascular dementiaAtypical parkinsonism |
| spellingShingle | David Fällmar Oliver Andersson Lena Kilander Malin Löwenmark Dag Nyholm Johan Virhammar Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism Fluids and Barriers of the CNS Normal pressure hydrocephalus Differential diagnostics Imaging features Vascular dementia Atypical parkinsonism |
| title | Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism |
| title_full | Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism |
| title_fullStr | Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism |
| title_full_unstemmed | Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism |
| title_short | Imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism |
| title_sort | imaging features associated with idiopathic normal pressure hydrocephalus have high specificity even when comparing with vascular dementia and atypical parkinsonism |
| topic | Normal pressure hydrocephalus Differential diagnostics Imaging features Vascular dementia Atypical parkinsonism |
| url | https://doi.org/10.1186/s12987-021-00270-3 |
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