Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Palm, W.M. Articles by van Buchem, M.A. Search for Related Content PubMed PubMed Citation Articles by Palm, W.M. Articles by van Buchem, M.A.

American Journal of Neuroradiology 27:76-79, January 2006
© 2006 American Society of Neuroradiology

BRAIN

Intracranial Compartment Volumes in Normal Pressure Hydrocephalus: Volumetric Assessment versus Outcome

W.M. Palm, R. Walchenbach, B. Bruinsma, F. Admiraal-Behloul, H.A.M. Middelkoop, L.J. Launer, J. van der Grond and M.A. van Buchem

Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
Department of Neuroepidemiology Section, National Institute on Aging, Bethesda, Md

Address correspondence to: Walter M. Palm, MD, Department of Radiology, Leiden University Medical Center, C2-S, P.O. Box 9600, 2300 RC Leiden, the Netherlands

Abstract

BACKGROUND AND PURPOSE: Although enlargement of the cerebral ventricles plays a central role in the diagnosis of normal pressure hydrocephalus (NPH), there are no reports on the use of volumetric assessment to distinguish between patients who respond to ventriculoperitoneal shunt surgery and those who do not. The purpose of this study is to explore the association between preoperative intracranial compartment volumes and postoperative improvement.

METHODS: Twenty-six patients (17 men; mean age, 75 years [range, 54–87 years]) with a clinical or radiologic suspicion of NPH were included in the study. Gait, cognition, and bladder function were evaluated by clinical rating. MR imaging of the brain was acquired at 0.5T and 1.5T. Total intracranial volume, ventricular volume, brain volume, and pericerebral CSF volume were determined by volumetric assessment. Four imaging variables were determined: ventricular volume ratio, brain volume ratio, pericerebral CSF volume ratio, and the ratio of ventricular volume to pericerebral CSF volume. All patients underwent ventriculoperitoneal shunt surgery.

RESULTS: Clinical follow-up was assessed 1 year after shunt surgery. No difference in the mean ventricular volume ratio, the mean brain volume ratio, the mean pericerebral CSF volume ratio, and the mean ratio between ventricular and pericerebral CSF volume was found between subjects who improved on gait or cognition or bladder function and those who did not.

CONCLUSION: Volumetric assessment has no predictive value in differentiating between NPH patients who respond to ventriculoperitoneal shunt surgery and those who do not.