Karki, Pragalv

ABSTRACT Background and Purpose In idiopathic normal pressure hydrocephalus (iNPH) patients, cerebrospinal fluid (CSF) flow is typically evaluated with a cardiac‐gated two‐dimensional (2D) phase‐contrast (PC) MRI through the cerebral aqueduct. This approach is limited by the evaluation of a single location and does not account for respiration effects on flow. In this study, we quantified the cardiac and respiratory contributions to CSF movement at multiple intracranial locations using a real‐time 2D PC‐MRI and evaluated the diagnostic value of CSF dynamics biomarkers in classifying iNPH patients. Methods This study included 37 participants: 16 iNPH, 10 Alzheimer's disease (AD), and 11 cognitively unimpaired (CU) controls. Anatomical and real‐time (non‐gated) PC images were acquired in a 3T Philips scanner. CSF flow was assessed at the foramen magnum, fourth ventricle, Sylvian fissure, lateral ventricle, and cerebral aqueduct. We calculated three CSF dynamics biomarkers: mean velocity amplitude, cardiac signal power, and respiratory signal power. Biomarkers from each location were evaluated for classifying iNPH versus AD and CU using support vector machine (SVM). A p ‐value of 0.05 or less was considered statistically significant. Results The velocity amplitude and cardiac signal power were significantly reduced in iNPH compared to CU ( p < 0.005) and AD ( p < 0.05) at the lateral ventricle. The SVM model using biomarkers from the lateral ventricle performed significantly better at classifying iNPH than the other locations in terms of accuracy ( p < 0.005) and diagnostic odds ratio ( p < 0.05). Conclusion Evaluation of CSF movement beyond the cerebral aqueduct may aid in identifying patients with and understanding the pathophysiology of iNPH.