Abstract：
Idiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable disorder, but prognostic tests or biomarkers are lacking. The aim was to study the predictive power of clinical, neuroimaging and lumbar infusion test parameters (resistance to outflow Rout , cardiac-related pulse amplitude PA and the PA to intracranial pressure ICP ratio).
In all, 127 patients diagnosed with iNPH who had a lumbar infusion test, a subsequent ventriculo-peritoneal shunt operation and at least 2 months of postoperative follow-up were retrospectively included. Preoperative magnetic resonance images were visually scored for NPH features using the iNPH Radscale. Preoperative and postoperative assessment was performed using cognitive testing, as well as gait and incontinence scales.
At follow-up (7.4 months, range 2-20 months), an overall positive response was seen in 82% of the patients. Gait was more severely impaired at baseline in responders compared to non-responders. The iNPH Radscale score was borderline significantly higher in responders compared with non-responders, whereas no significant differences in infusion test parameters were seen between responders and non-responders. Infusion test parameters performed modestly with high positive (75%-92%) but low negative (17%-23%) predictive values. Although not significant, PA and PA/ICP seemed to perform better than Rout , and the odds ratio for shunt response seemed to increase in patients with higher PA/ICP, especially in patients with lower iNPH Radscale scores.
Although only indicative, lumbar infusion test results increased the likelihood of a positive shunt outcome. Pulse amplitude measures showed promising results that should be further explored in prospective studies.
In all, 127 patients diagnosed with iNPH who had a lumbar infusion test, a subsequent ventriculo-peritoneal shunt operation and at least 2 months of postoperative follow-up were retrospectively included. Preoperative magnetic resonance images were visually scored for NPH features using the iNPH Radscale. Preoperative and postoperative assessment was performed using cognitive testing, as well as gait and incontinence scales.
At follow-up (7.4 months, range 2-20 months), an overall positive response was seen in 82% of the patients. Gait was more severely impaired at baseline in responders compared to non-responders. The iNPH Radscale score was borderline significantly higher in responders compared with non-responders, whereas no significant differences in infusion test parameters were seen between responders and non-responders. Infusion test parameters performed modestly with high positive (75%-92%) but low negative (17%-23%) predictive values. Although not significant, PA and PA/ICP seemed to perform better than Rout , and the odds ratio for shunt response seemed to increase in patients with higher PA/ICP, especially in patients with lower iNPH Radscale scores.
Although only indicative, lumbar infusion test results increased the likelihood of a positive shunt outcome. Pulse amplitude measures showed promising results that should be further explored in prospective studies.
摘要：
背景：特发性正常压力脑积水（iNPH）是一种潜在的可治疗疾病，但缺乏预后测试或生物标志物。我们的目的是研究临床的预测能力，神经影像学和腰椎输液测试参数(流出阻力(Rout)，心脏相关脉冲振幅(PA),和PA与颅内压（ICP）的比率）。
方法：我们回顾性地纳入了127例诊断为iNPH的患者，这些患者进行了腰椎输注试验，随后的脑室-腹腔分流术,术后至少2个月随访。使用iNPHradscale对术前MR图像的NPH特征进行视觉评分。使用认知测试进行术前和术后评估，以及步态和失禁量表。
结果：随访（7,4个月，范围2-20个月)。82%的患者出现总体阳性反应.与非反应者相比，反应者在基线时步态受损更严重。与无应答者相比，应答者的iNPHradscale评分明显较高，而应答者和非应答者之间的输注测试参数没有显著差异.输注测试参数表现适中，具有高阳性（75-92％）但低阴性（17-23％）的预测值。虽然不重要，PA和PA/ICP似乎比Rout表现更好，在PA/ICP较高的患者中，分流反应的比值比似乎增加，尤其是iNPHradscale评分较低的患者。
结论：尽管只是指示性的，腰椎灌注试验结果增加了分流结果阳性的可能性.脉冲幅度测量显示有希望的结果，这应该在前瞻性研究中进一步探讨。
方法：我们回顾性地纳入了127例诊断为iNPH的患者，这些患者进行了腰椎输注试验，随后的脑室-腹腔分流术,术后至少2个月随访。使用iNPHradscale对术前MR图像的NPH特征进行视觉评分。使用认知测试进行术前和术后评估，以及步态和失禁量表。
结果：随访（7,4个月，范围2-20个月)。82%的患者出现总体阳性反应.与非反应者相比，反应者在基线时步态受损更严重。与无应答者相比，应答者的iNPHradscale评分明显较高，而应答者和非应答者之间的输注测试参数没有显著差异.输注测试参数表现适中，具有高阳性（75-92％）但低阴性（17-23％）的预测值。虽然不重要，PA和PA/ICP似乎比Rout表现更好，在PA/ICP较高的患者中，分流反应的比值比似乎增加，尤其是iNPHradscale评分较低的患者。
结论：尽管只是指示性的，腰椎灌注试验结果增加了分流结果阳性的可能性.脉冲幅度测量显示有希望的结果，这应该在前瞻性研究中进一步探讨。
