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Takagi K, Watahiki R, Machida T, et al. Reliability and Interobserver Variability of Evans' Index and Disproportionately Enlarged Subarachnoid Space Hydrocephalus as Diagnostic Criteria for Idiopathic Normal Pressure Hydrocephalus. Asian J Neurosurg. 2020;15(1):107-112doi: 10.4103/ajns.AJNS_354_19.
Takagi, K., Watahiki, R., Machida, T., Onouchi, K., Kato, K., & Oshima, M. (2020). Reliability and Interobserver Variability of Evans' Index and Disproportionately Enlarged Subarachnoid Space Hydrocephalus as Diagnostic Criteria for Idiopathic Normal Pressure Hydrocephalus. Asian journal of neurosurgery, 15(1), 107-112. https://doi.org/10.4103/ajns.AJNS_354_19
Takagi, Kiyoshi, et al. "Reliability and Interobserver Variability of Evans' Index and Disproportionately Enlarged Subarachnoid Space Hydrocephalus as Diagnostic Criteria for Idiopathic Normal Pressure Hydrocephalus." Asian journal of neurosurgery vol. 15,1 (2020): 107-112. doi: https://doi.org/10.4103/ajns.AJNS_354_19
Takagi K, Watahiki R, Machida T, Onouchi K, Kato K, Oshima M. Reliability and Interobserver Variability of Evans' Index and Disproportionately Enlarged Subarachnoid Space Hydrocephalus as Diagnostic Criteria for Idiopathic Normal Pressure Hydrocephalus. Asian J Neurosurg. 2020 Feb 25;15(1):107-112. doi: 10.4103/ajns.AJNS_354_19. eCollection 2020. PMID: 32181182; PMCID: PMC7057886.
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Asian J Neurosurg. 2020 Feb 25;15(1):107-112. doi: 10.4103/ajns.AJNS_354_19. eCollection 2020.

Reliability and Interobserver Variability of Evans' Index and Disproportionately Enlarged Subarachnoid Space Hydrocephalus as Diagnostic Criteria for Idiopathic Normal Pressure Hydrocephalus.

Asian journal of neurosurgery

Kiyoshi Takagi, Ryota Watahiki, Toru Machida, Kenji Onouchi, Kazuyoshi Kato, Marie Oshima

Affiliations

  1. Normal Pressure Hydrocephalus Center, Kashiwatanaka Hospital, Kashiwa (Current institute: Normal Pressure Hydrocephalus Center, Nagareyama Central Hospital, Nagareyama), Tsukuba, Japan.
  2. Department of Mechanical and Biofunctional Systems, Institute of Industrial Science, The University of Tokyo, Tsukuba, Japan.
  3. Department of Rehabilitation, Tsukuba Medical Center Hospital, Tsukuba, Japan.
  4. Center for Diagnostic Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
  5. Department of Neurology, Tsukuba Hospital, Tsukuba, Japan.
  6. Department of Surgery, Abiko Seijinkai Hospital, Abiko, Japan.

PMID: 32181182 PMCID: PMC7057886 DOI: 10.4103/ajns.AJNS_354_19

Abstract

BACKGROUND: The image diagnosis of idiopathic normal-pressure hydrocephalus (iNPH) is based on the ventriculomegaly, whose criterion is an Evans' Index (EI) >0.3. Recently, disproportionately enlarged subarachnoid space hydrocephalus (DESH) has been proposed as a morphological characteristic to iNPH. Several studies cast doubt on the reliability of these criteria in the diagnosis of iNPH. Furthermore, interobserver differences of these criteria have not yet been investigated. The objective of this study was to assess the diagnostic reliability and interobserver variability of EI and DESH.

MATERIALS AND METHODS: The preoperative magnetic resonance (MR) images of 84 definite iNPH patients were retrospectively evaluated by a neuroradiologist (NR) and physical therapist (PT). They independently assessed the EI and DESH. The MR images were evaluated preoperatively by a neurosurgeon (NS). The results were showed in mean (standard deviation).

RESULTS: The mean age was 78.4 (6.3) years (male:female = 49:35). The mean EI was 0.33 (0.04), 0.32 (0.04), and 0.31 (0.03) for NS, NR, and PT, respectively (

CONCLUSION: This study suggests that DESH cannot be a diagnostic criterion for iNPH. If EI >0.3 and DESH were both necessary to diagnose iNPH, then more than 70% of patients would have been misdiagnosed and would have been deprived of the chance of treatment and its benefits. These results request a paradigm shift in the concepts of iNPH.

Copyright: © 2020 Asian Journal of Neurosurgery.

Keywords: Disproportionately enlarged subarachnoid space hydrocephalus; Evans' Index; idiopathic normal pressure hydrocephalus; interobserver variability; ventriculoatrial shunt

Conflict of interest statement

There are no conflicts of interest.

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