Artikel
Is the quantative non invasive cine MR CSF flow rate study capable of replacing the invasive diagnostic methods in diagnosing normal pressure hydrocephalus?
Kann die noninvasive MR-Liquorflussmessung invasie Diagnostikmethoden (ICP-Messung, Infusionstest, Cerebrospinal tap test) beim idiopathischen Normaldruckhydrozephalus ersetzen?
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Autoren
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F. Al-Zain
- Department of Neurosurgery, Unfallkrankenhaus Berlin
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G. Rademacher
- Institute of Radiology, Unfallkrankenhaus Berlin
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S. Mutze
- Institute of Radiology, Unfallkrankenhaus Berlin
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U. Meier
- Department of Neurosurgery, Unfallkrankenhaus Berlin
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: To determine whether the CSF flow study using cine MR imaging is capable of replacing the invasive diagnostic methods like ICP measurments, dynamic infusion test and spinal tap test to divide patients having one, all or a combination of the classical Hakim triad (gait disturbance, urinary incontinence and cognitive impairment) into normal pressure hydrocephalus and brain atrophy.
Methods: Between January 2003 and April 2005, 61 patients (27 women and 34 men; mean age, 68.6 years; range, 27-87 years), having one, all or a combination of the classical Hakim triad and an Evan´s index of more than 0.30 in cranial computer tomography underwent the dynamic intrathecal infusion test, cerebro-spinal tap test and cine MR imaging to determine the flow rate of the CSF in the aqueduct. The indication criteria for shunting depended on the clinical symptoms, CT-Diagnostic, results of dynamic infusion test and cerebro-spinal tap test. The patients undergone surgery were controlled postperatively in a period ranging from 3 to 12 monthes. The pre- and postoperative cinical symptoms were measured by using the Homburg score of Kiefer and the outcome by the Meier NPH recovery rate.
Results: According to the above mentioned criteria, the patient were divided into 41 with NPH and 20 with brain atrophy. Out of the 41 NPH patients 39 were shunted and 2 patient did not agree to surgery. these 39 patients were controlled over a period up to 12 months. The mean Kiefer score for all patients pre- and post-operatively had a significant statistical difference (P<0.001) in favour of an good to excellent outcome in 67%, fair outcome in 23% and only 10% with poor outcome. Retrospectively, the cine MR CSF flow rate measurments in the aqueduct of these patients were analysed to find out that a flow rate of more than 24.5 ml/min is 95% specific to the normal pressure hydrocephalus patients.
Conclusions: CSF flow rate in the aqueduct by using cine MR imaging is a good screening method for normal pressure hydrocephalus. This method has a high specifity to NPH but a low sensitivity. The suspected patients having normal presure hydrocephalus with false negative results will eventually need the up to now used invasive methods, like the dynamic intrathecal infusion test.
