Brain MRI as a predictor of CSF tap test response in patients with idiopathic normal pressure hydrocephalus

In this study, our objective was to identify the characteristic morphological features of brain MRI associated with a positive cerebrospinal fluid (CSF) tap test in patients with idiopathic normal pressure hydrocephalus (iNPH). Patients diagnosed with clinical suspected iNPH were evaluated. All patients underwent a mini-mental state examination, a brain MRI, and a CSF tap test. The severities of clinical symptoms were rated before and after the CSF tap test. Characteristic brain MRI findings including frontal convexity narrowing, parietal convexity narrowing, upward bowing of the corpus callosum, empty sella, narrowing of the CSF space at the high convexity, marked dilatation of the Sylvian fissure, and disproportion between narrowing of the CSF space at the high convexity and dilatation of the Sylvian fissure ("mismatch" sign) on T1-weighted or FLAIR image were analyzed. Forty-three patients (33 males/ten females, mean age 76.9 ± 6.9 years) with possible iNPH participated in this study. The presence versus absence of empty sella (52.4 vs. 14.3%, OR 6.6, 95% CI 1.5-29.4, p = 0.02) and "mismatch" sign (45.5 vs. 9.5%, OR 7.9, 95% CI 1.5-42.5, p = 0.02) were associated with positive CSF tap test responses. The sensitivity, specificity, positive predictive value, and negative predictive value of the presence of either of these two MRI features in the prediction of CSF tap response were 72.7, 81, 80, and 73.9%, respectively. Specific brain MRI features can be used as markers for the identification of potential CSF tap test responders in iNPH patients. These features may serve as supplemental evidence in the diagnosis of iNPH patients.