Brain MRI has a key role in the diagnosis of idiopathic Normal Pressure Hydrocephalus and is supportive in the selection of shunt candidates. This course will present an overview of the diagnostic and prognostic value of imaging features. A systematic approach to imaging evaluation and structured reporting of the findings enables comparison between sites and longitudinal follow-up of patients.
To step away from subjective readings of the aging brain
To identify radiological signs of iNPH, and have a strategy for reporting it
To use radiological markers in follow up and evaluation of shunt outcome in patients with iNPH
To go through the radiological criteria of the diagnostic guidelines of iNPH, including Evans’ index, temporal horn enlargement, periventricular white matter changes, disproportional dilation and narrowing of sulci and callosal angle. What and how to measure.
Ventriculomegaly: Evans index vs volumetry
Basic MRI protocol for iNPH: morphology, source of obstruction, differential diagnosis
Give a brief review of the current scientific evidence of the diagnostic and prognostic value of imaging signs.
Association between imaging signs and symptoms
Association between imaging signs and shunt response
Changes in imaging signs over time and after shunt insertion
In what context can we use imaging within the care of patients with suspicion of or diagnosed with iNPH?
Address the problem of semiquantitative scales. “Moderate dilation” can have different meaning for different radiologists.
Mori E, Ishikawa M, Kato T et al (2012) Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir (Tokyo) 52:775-809
Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S4-16; discussion ii-v