Diagnostic and Interventional Radiology
Neuroradiology - Original Article

MR cisternography: is it useful in the diagnosis of normal-pressure hydrocephalus and the selection of “good shunt responders”?

1.

Departments of Radiology, Uludağ University Faculty of Medicine, Bursa, Turkey

2.

Department of Radiology, Uludag University School of Medicine, Bursa, Turkey

3.

Department of Biostatistics, Uludağ University Faculty of Medicine, Bursa, Turkey

4.

Uludağ Üniversitesi Tıp Fakültesi, Radyoloji Anabilim Dalı, Bursa

Diagn Interv Radiol 2011; 17: 105-111
DOI: 10.4261/1305-3825.DIR.3133-09.1
Read: 690 Downloads: 545 Published: 03 September 2019

Abstract

PURPOSE
The aim of this study was to evaluate the efficiency of MR cisternography (MRC) in the diagnosis of idiopathic normalpressure hydrocephalus (INPH) and in the prediction of the response to shunt treatment.

 

MATERIALS AND METHODS
Thirty-six patients with the diagnosis of “probable INPH” were included in the study group and 15 asymptomatic age-matched individuals were included in the control group. Pre-contrast T1-weighted (T1W) imaging was followed by intrathecal administration of 1 ml gadopentetate dimeglumine. Post-contrast T1W images were taken at the 12th, 24th and 48th hours. The presence of contrast material in the lateral ventricles for more than 24 hours was accepted as a positive diagnosis of INPH. Data from both groups were compared statistically. Statistical significance was accepted for P < 0.05.

 

RESULTS
All of the INPH patients had remaining contrast material in their lateral ventricles at the 12th and 24th hours, while only 28 (78%) patients had contrast material remaining at the 48th hour after MRC. Only 3 (20%) of the control cases had remaining contrast material in their lateral ventricles at the 24th hour. No contrast material was present in the control cases at the 48th hour. The contrast material was found to be significantly more prevalent in the INPH patients at the 24th and the 48th hours compared with the control cases (P < 0.001). Shunt placement was performed in 14 INPH patients, and eight improved after shunt placement. All patients (100%) who improved after shunt placement had remaining contrast material in their lateral ventricles at the 24th and at the 48th hours. The sensitivity and specificity of MRC in the prediction of the response to shunt treatment were 100% and 17%, respectively.

 

CONCLUSION
MRC does not use ionizing radiation and is generally a useful procedure to diagnose NPH and to predict a positive response to shunt treatment; thus, we recommend MRC after routine MRI in patients with the presumed diagnosis of NPH.

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EISSN 1305-3612