Systematic volumetric analysis predicts response to CSF drainage and outcome to shunt surgery in idiopathic normal pressure hydrocephalus.

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Abstrakt

Tytuł:: Systematic volumetric analysis predicts response to CSF drainage and outcome to shunt surgery in idiopathic normal pressure hydrocephalus.
Autorzy:: Wu D; Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, Zhejiang, China.
Moghekar A; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
Shi W; Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, Zhejiang, China.
Blitz AM; Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, OH, 44106, USA.
Mori S; Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, OH, 44106, USA. .; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, 21205, USA. .
Źródło:: European radiology [Eur Radiol] 2021 Jul; Vol. 31 (7), pp. 4972-4980. Date of Electronic Publication: 2021 Jan 03.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Berlin : Springer International, c1991-
MeSH Terms:: Hydrocephalus, Normal Pressure*/diagnostic imaging
Hydrocephalus, Normal Pressure*/surgery
Cerebrospinal Fluid Shunts ; Drainage ; Humans ; Neuroimaging ; Retrospective Studies
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Grant Information:: 2018YFE0114600 Ministry of Science and Technology of the People's Republic of China; 61801424, 81971606, 91859201 National Natural Science Foundation of China; 2019QNA5024 Fundamental Research Funds for the Central Universities
Contributed Indexing:: Keywords: Algorithm; Hydrocephalus; Normal pressure; Segmentation; Volume
Entry Date(s):: Date Created: 20210103 Date Completed: 20210623 Latest Revision: 20210708
Update Code:: 20240105
PubMed Central ID:: PMC8213563
DOI:: 10.1007/s00330-020-07531-z
PMID:: 33389035
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Objectives: Idiopathic normal pressure hydrocephalus (INPH) is a neurodegenerative disorder characterized by excess cerebrospinal fluid (CSF) in the ventricles, which can be diagnosed by invasive CSF drainage test and treated by shunt placement. Here, we aim to investigate the diagnostic and prognostic power of systematic volumetric analysis based on brain structural MRI for INPH.
Methods: We performed a retrospective study with a cohort of 104 probable INPH patients who underwent CSF drainage tests and another cohort of 41 INPH patients who had shunt placement. High-resolution T1-weighted images of the patients were segmented using an automated pipeline into 283 structures that are grouped into different granularity levels for volumetric analysis. Volumes at multi-granularity levels were used in a recursive feature elimination model to classify CSF drainage responders and non-responders. We then used pre-surgical brain volumes to predict Tinetti and MMSE scores after shunting, based on the least absolute shrinkage and selection operator.
Results: The classification accuracy of differentiating the CSF drainage responders and non-responders increased as the granularity increased. The highest diagnostic accuracy was achieved at the finest segmentation with a sensitivity/specificity/precision/accuracy of 0.89/0.91/0.84/0.90 and an area under the curve of 0.94. The predicted post-surgical neurological scores showed high correlations with the ground truth, with r = 0.80 for Tinetti and r = 0.88 for MMSE. The anatomical features that played important roles in the diagnostic and prognostic tasks were also illustrated.
Conclusions: We demonstrated that volumetric analysis with fine segmentation could reliably differentiate CSF drainage responders from other INPH-like patients, and it could accurately predict the neurological outcomes after shunting.
Key Points: • We performed a fully automated segmentation of brain MRI at multiple granularity levels for systematic volumetric analysis of idiopathic normal pressure hydrocephalus (INPH) patients. • We were able to differentiate patients that responded to CSF drainage test with an accuracy of 0.90 and area under the curve of 0.94 in a cohort of 104 probable INPH patients, as well as to predict the post-shunt gait and cognitive scores with a coefficient of 0.80 for Tinetti and 0.88 for MMSE. • Feature analysis showed the inferior lateral ventricle, bilateral hippocampus, and orbital cortex are positive indicators of CSF drainage responders, whereas the posterior deep white matter and parietal subcortical white matter were negative predictors.

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