Characterization of Radiological Markers in Relation to Time Elapsed Between Appearance and Ventriculoperitoneal Shunt Placement

Objective

This study was conducted to evaluate the time gap between earliest head computed tomography (CT) with a significant Radscale score and ventriculoperitoneal (VP) shunt placement.

Methods

The study is a retrospective observational analytical study. The study population includes patients with idiopathic normal pressure hydrocephalus treated with a VP shunt in a single center between the years 2016 and 2022 and who have at least 2 CTs, one in proximity to diagnosis and another obtained at an earlier time point. The correlation among the parameters is tested with statistical analysis software.

Results

A total of 34 patients (mean age ± SD, 72.32 ± 7.24 years) were evaluated. Based on the diagnostic CT among the Radscale parameters, 94.1% of patients had high Evans index score, 79.4% had enlarged sylvian fissures, and 85.3% had enlargement of the temporal horns. A total of 79.4% had normal structure of sulci. The median time duration between the earliest CT with a significant Radscale score and VP shunt placement was 9.2 months (interquartile range, 1.9–27.2 months).

Conclusions

Evans index, enlarged sylvian fissures, and enlargement of the temporal horns have been observed in most diagnostic CTs. The median diagnosis time of idiopathic normal pressure hydrocephalus since appearance of radiologic markers is 9.2 months, making awareness and communication between referral and radiologist crucial.