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ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Neurocognitive Aging and Behavior
Volume 17 - 2025 | doi: 10.3389/fnagi.2025.1509493
This article is part of the Research Topic Progress in the Assessment and Intervention of Neurocognitive Aging and Neurodegenerative Diseases View all 12 articles
Title： Preoperative Imaging Biomarkers Combined with Tap Test for Predicting Shunt Surgery Outcome in Idiopathic Normal Pressure Hydrocephalus: A Multicenter Retrospective Study
Provisionally accepted
Wei Gao 1
Wei Liu 2
Yuqi Ying 1
Qingze Zeng 1
Jiadong Wang 3
Jingquan Lin 1
Guo Xinxia 1
Hongjie Jiang 1
Zhe Zheng 1
Zhoule Zhu 1
Junming Zhu 1*- 1 Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- 2 Changxing People's Hospital, Huzhou, Zhejiang Province, China
- 3 Second Hospital of Jiaxing City, Jiaxing, Zhejiang Province, China
The study aims to investigate the predictive performance of preoperative imaging features combined with tap test for the outcomes of ventriculoperitoneal (VP) shunt in idiopathic normal pressure hydrocephalus (iNPH). Methods In this multicenter retrospective study, 166 iNPH patients who underwent VP shunt surgery between August 2019 and November 2023 were included. Preoperative clinical characteristics and imaging features were collected. Preoperative clinical assessment and at least 3 months of postoperative follow-up were performed. Multivariable logistic regression, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) were used to evaluate predictive performance. Result Out of 166 total patients, 96 were responders and 70 non-responders. The tap test showed significant difference between two group (p < 0.01). Multivariable logistic regression identified that a positive disproportionately enlarged subarachnoid space (DESH) sign (OR = 0.09, 95% CI: 0.04-0.22, p < 0.001) and a sharper callosal angle (CA) (OR = 0.97, 95% CI: 0.95-1.00, p = 0.02) were associated with symptom improvement after shunt. The sensitivity, specificity, and AUC of tap test were 0.64, 0.60, and 0.62, respectively. Combining CA and the tap test increased sensitivity to 0.85, while combining DESH, CA, and the tap test improved specificity and AUC to 0.67 and 0.72, respectively. Conclusions The findings suggest that the imaging features DESH and CA, when combined with the tap test, enhance the prediction of VP shunt outcomes in iNPH patients. Despite the improved predictive capability, further research focusing on innovative biomarkers for VP shunt is warranted.
Keywords: idiopathic normal pressure hydrocephalus, Neuroimaging, Shunt surgery, imaging biomarkers, Tap test
Received: 11 Oct 2024; Accepted: 17 Feb 2025.
Copyright: © 2025 Gao, Liu, Ying, Zeng, Wang, Lin, Xinxia, Jiang, Zheng, Zhu and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Junming Zhu, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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