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The idiopathic normal-pressure hydrocephalus Radscale: a radiological scale for structured evaluation
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.ORCID-id: 0000-0002-4686-0941
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
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2018 (Engelska)Ingår i: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 25, nr 3, s. 569-576Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and purpose: Despite the important role of imaging in diagnosing idiopathic normal‐pressure hydrocephalus (iNPH), a structured overall assessment of radiological signs is still lacking. The purpose of this study was to construct a radiological scale, composed of morphological signs of iNPH, and compare it with clinical symptoms.

Methods: In this prospective, population‐based study of iNPH, 168 individuals (93 females) [mean age 75 (range 66–92) years] underwent computed tomography of the brain and a neurological examination with assessment of clinical symptoms according to Hellström's iNPH scale. Two radiologists, blinded to clinical data, independently evaluated and measured eight radiological parameters, i.e. Evans’ index, callosal angle, size of temporal horns, narrow high‐convexity sulci, dilated Sylvian fissures, focally dilated sulci, peri‐ventricular hypodensities and bulging of the lateral ventricular roof.

Results: In a linear regression model, all parameters except ventricular roof bulging were significantly associated with clinical iNPH symptoms. The seven remaining parameters were summarized into a total iNPH Radscale score ranging from 0 to 12. There was a significant correlation (r = 0.55, < 0.001) between the total iNPH Radscale score and clinical symptoms. The inter‐rater agreement for the included radiological parameters was high (intraclass correlation, 0.74–0.97).

Conclusion: The iNPH Radscale may become a valuable diagnostic screening tool, allowing a structured radiological assessment. A high iNPH Radscale score together with clinical symptoms should raise suspicion of iNPH, motivating further evaluation for shunt surgery.

Ort, förlag, år, upplaga, sidor
2018. Vol. 25, nr 3, s. 569-576
Nyckelord [en]
computed tomography, neurologic gait disorders, normal pressure hydrocephalus, memory disorders
Nationell ämneskategori
Radiologi och bildbehandling
Identifikatorer
URN: urn:nbn:se:umu:diva-145580DOI: 10.1111/ene.13555ISI: 000425631500025PubMedID: 29281156Scopus ID: 2-s2.0-85042358989OAI: oai:DiVA.org:umu-145580DiVA, id: diva2:1192239
Tillgänglig från: 2018-03-22 Skapad: 2018-03-22 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Ingår i avhandling
1. Imaging in Idiopathic Normal Pressure Hydrocephalus: The value of structured radiological evaluation
Öppna denna publikation i ny flik eller fönster >>Imaging in Idiopathic Normal Pressure Hydrocephalus: The value of structured radiological evaluation
2020 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Bilddiagnostik vid idiopatisk normaltryckshydrocephalus : Värdet av strukturerad radiologisk utvärdering
Abstract [en]

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a neurological condition where the symptoms include disturbed gait, balance, cognition and continence. The diagnostic guidelines are based on typical symptoms combined with imaging showing enlarged ventricles. Several scales for evaluating symptoms exist, but no corresponding tool is in use for imaging. The aim of this thesis was to construct a radiological scoring system, the iNPH Radscale, to facilitate radiological evaluation and systematic reporting of changes. Further, to test the reliability and accuracy of the scale and evaluate the usefulness for longitudinal monitoring.

Methods: In paper I 168 individuals over 65 years of age from the general population underwent computed tomography (CT) of the brain and a neurological examination, and the same cohort was followed up 2 years later in paper IV. The iNPH Radscale was developed in these papers and further validated in papers II and III. Papers II and III included surgically treated iNPH patients with preoperative imaging of the brain. Thirty-five patients were included in paper II comparing preoperative CT and magnetic resonance imaging (MRI) using the iNPH Radscale. Paper III included 75 shunt responsive patients and 55 asymptomatic controls to evaluate the accuracy of the iNPH Radscale.

Results: In paper I, seven parameters summarized as a total iNPH Radscale score were significantly associated with clinical iNPH symptoms (r = 0.55, p < 0.001). In paper II, the agreement between CT and MRI was substantial to almost perfect (kappa and intraclass correlation, 0.60–0.91, p < 0.001) for all parameters except periventricular white matter changes. In paper III the iNPH Radscale score was significantly higher in the iNPH group than the control group (p <0.001). Receiver operating characteristics analysis yielded an area under the curve of 99.7 %, and an iNPH Radscale score £ 4 identified those without iNPH (sensitivity 100 %, specificity 96 % and overall accuracy 98.5 %). In paper IV, symptomatic participants had significantly higher iNPH Radscale scores at baseline and follow-up.

Conclusions: The iNPH Radscale summarizes seven imaging features from the diagnostic guidelines and is applicable to both CT and MRI. INPH is very likely in patients with an iNPH Radscale score ³ 8 and corresponding clinical symptoms. On the other hand, the diagnosis should be questioned when the iNPH Radscale score is less than the cut-off of 4. In summary, the iNPH Radscale may become a relevant diagnostic tool for standardized evaluation in the workup of patients with suspected iNPH, as a diagnostic checklist and as a screening tool for detection with the potential for ruling out the disease.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå Universitet, 2020. s. 67
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2074
Nyckelord
normal pressure hydrocephalus, gait disorder, computed tomography, magnetic resonance imaging
Nationell ämneskategori
Radiologi och bildbehandling
Forskningsämne
diagnostisk radiologi
Identifikatorer
urn:nbn:se:umu:diva-169521 (URN)978-91-7855-216-0 (ISBN)978-91-7855-215-3 (ISBN)
Disputation
2020-05-29, Hörsalen Snäckan, Östersunds sjukhus, Östersund, 09:00 (Svenska)
Opponent
Handledare
Anmärkning

Hörsalen är stängd för allmänheten så länge Corona-pandemin fortgår. Med anledning av disputationen 29 maj, öppnas Hösalen tillfälligt för de personer som absolut måste närvara fysiskt, för att disputationsakten ska godkännas. Allmänheten kommer kunna delta vid livesändning via länken: https://m.youtube.com/watch?feature=youtu.be&v=k2gw3eOyYxE

Tillgänglig från: 2020-05-08 Skapad: 2020-05-03 Senast uppdaterad: 2023-03-07Bibliografiskt granskad
2. A population-based study on neuropsychological and morphological signs of idiopathic normal pressure hydrocephalus
Öppna denna publikation i ny flik eller fönster >>A population-based study on neuropsychological and morphological signs of idiopathic normal pressure hydrocephalus
2022 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is typically manifested in people over 65 years. The condition of gait disturbances, incontinence, and cognitive dysfunction can be reversed in up to 80% of the cases by ventricular shunting. Neuropsychological testing and standardized brain imaging of signs of iNPH are essential to detect and define the progression. The aims of this thesis were to develop a radiological iNPH scale, examine how morphological features relate to symptoms of iNPH, investigate if dual-task testing (e.g., walking and talking) is helpful in detecting iNPH, and monitor developing symptoms over two years.

METHOD: The studies include 168 participants (median [range] age 73 [66–92]) at baseline (2014/2015) and 104 participants (age 75 [68–91]) at follow-up (2016/2017) from the general population. Neuropsychological tests of executive functions, memory, and motor performance, and computed tomography (CT) for brain imaging were used.

RESULTS: Seven morphological features were combined into a scoring scale for iNPH. The total score correlated with clinical symptoms (r = -0.40, p <.001). All core symptoms were associated to wider temporal horns (TH) (p <.01). Participants with iNPH stopped walking to talk more frequently (p = .044). Participants who developed iNPH during the study worsened more on declarative memory (ES -0.37).

DISCUSSION: The Radscale was related to symptoms of iNPH and the TH to all main clinical features. Difficulties walking while recalling a previous event, worsened declarative memory, and expanding ventricular space surrounding the hippocampus were noticeable signs of iNPH. Memory functions are important to recognize in iNPH.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2022. s. 86
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2200
Nyckelord
idiopathic normal pressure hydrocephalus, cognition, dual-task, ageing, temporal horns, morphology, memory, executive function
Nationell ämneskategori
Neurologi
Forskningsämne
neurologi
Identifikatorer
urn:nbn:se:umu:diva-201142 (URN)978-91-7855-889-6 (ISBN)978-91-7855-890-2 (ISBN)
Disputation
2022-12-15, Hörsalen Snäckan, Östersund sjukhus, Östersund, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2022-11-24 Skapad: 2022-11-21 Senast uppdaterad: 2022-12-02Bibliografiskt granskad

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Kockum, KarinLilja-Lund, OttoLaurell, Katarina

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