AUTHOR=He Wen-Jie , Zhang Xie-jun , Xu Qi-Zhong , Bai Run-tao , Chen Jia-kuan , Zhou Xi , Xia Jun 

TITLE=Are preoperative phase-contrast CSF flow parameters ideal for predicting the outcome of shunt surgery in patients with idiopathic normal pressure hydrocephalus?

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.959450

DOI=10.3389/fneur.2022.959450

ISSN=1664-2295

ABSTRACT=Purpose: Phase-contrast magnetic resonance (PC-MR) is widely-used in patients with idiopathic normal pressure hydrocephalus (iNPH), but its role in predicting prognosis remains controversial. To evaluate the effectiveness of preoperative PC-MR CSF flow measurement in predicting the clinical response to shunt surgery in patients with iNPH. 
Methods: Forty-six patients with definite iNPH were included between January 2018 and January 2022. PC-MR was used to evaluate CSF peak velocity (PV), average velocity, aqueductal stroke volume (ASV), net ASV, and net flow. The modified Rankin Scale (mRS), iNPH grading scale (iNPHGS), mini-mental state examination (MMSE), and timed 3-meter up and go test (TUG) were used for clinical assessment. The primary endpoint was improvement in the mRS score at 1 year after surgery, and the secondary endpoints were the iNPHGS, MMSE, and TUG scores at 1 year. Differences between shunt improvement and non- improvement groups, based on the clinical outcomes, were compared using the Mann-Whitney U test, logistic regression models and receiver operating characteristic curves. Correlations between CSF flow parameters and the baseline clinical outcomes were assessed using Spearman’s correlation coefficient.
Results: No CSF parameters significantly differed between shunt improvement and non- improvement groups based on mRS and secondary outcomes. And all CSF parameters showed significant overlap in both shunt improvement and non- improvement groups based on mRS and secondary outcomes. Significant correlations between the mRS and iNPHGS scores, and PV, ASV, and net ASV were observed. 
Conclusions: While some preoperative PC-MR CSF flow parameters reflected the symptom severity of iNPH to a certain extent, they alone might not be ideal markers of shunt responsiveness.