AQ-PCMR cannot predict the prognosis of CAH patient shunt

Chronic hydrocephalus (CAH) in adults occurs mostly in the elderly and is often characterized by gait instability, cognitive impairment and urinary incontinence; imaging tests indicate brain ventricular enlargementCAH is one of the causes of dementia, and ventricular celiac shunts or ventricular ventricular shunts can improve the symptoms of CAHHowever, clinical or imaging diagnosis of CAH is still very difficult because gait, urinary and cognitive impairments are common in older people, and ventricular enlargement can also be the result of brain atrophy or normal agingHowever, CAH is chronically untreated and its symptoms may be irreversible- Excerpted from the article chapter: Blitz AM, et alAJNR Am J Neuroradiol2018 Dec;39 (12): 2224-2230doi: 10.3174/ajnrA5857Epub 2018 Nov 22.)chronic hydrocephalus (CAH) in adults mostly occurs in the elderly, often characterized by gait instability, cognitive impairment and urinary incontinence triple signs; imaging tests indicate brain ventricular enlargementCAH is one of the causes of dementia, and ventricular celiac shunts or ventricular ventricular shunts can improve the symptoms of CAHHowever, clinical or imaging diagnosis of CAH is still very difficult because gait, urinary and cognitive impairments are common in older people, and ventricular enlargement can also be the result of brain atrophy or normal agingHowever, CAH is chronically untreated and its symptoms may be irreversibleTherefore, it is very important to predict the efficacy of shuntLumbar puncture (LP) or lumbar drainage (lumbar drainage, LD) has been used to screen for reversible CAH patients, but is traumatic, and the presence of negative predictions of less than 20% excludes some patients who may benefit from surgery Currently, a noninvasive pipe phase contrast MRI imaging (aqueductal phase-contrast-MRI, AQ-PCMR) technology is used in clinical practice However, the effect of AQ-PCMR diagnosis of CAH is controversial Ari M Blitz of the Department of Neuroradiology at Johns Hopkins University School of Medicine in Maryland and others conducted retrospective studies to determine whether AQ-PCMR could predict the prognosis of LP or LD and cerebrospinal fluid shunt surgery for CAH The results were published in the December 2018 issue of Am J Neuroradiol the study reviewed 185 adult chronic hydrocephalus patients admitted between March 2010 and August 2014 Of these, 83 were women and 102 were men; 185 patients received high-resolution magnetic resonance imaging and AQ-PCMR imaging prior to the diagnostic lumbar puncture to assess the smoothness of the brain's water ducts and their clinical lysis The researchers analyzed AQ-PCMR imaging in 185 patients using the CSF Flow package The effect of lumbar puncture or lumbar pool drainage and cerebrospinal fluid shunt was evaluated by quantitative and qualitative measurement methods Quantitative tests, including Tinetti tests, stand-walk timing tests, and mini-mind tests (MMSE), qualitative measurements, including improvements in gait, urination, and cognitive function Combined with quantitative analysis of AQ-PCMR imaging and clinical resultmeasurement the results of the showed that there was overlap between the per-fight output and flow rate of the cerebrospinal spinal fluid in the lumbar vertebral puncture or the lumbar pool drainage between the responderand and the non-responder, and there was also significant overlap between the responders with the cerebrospinal fluid shunt and the non-responders The output or flow rate of pure guide pipes per beat is not a good predictor of lumbar puncture or lumbar pool drainage and cerebrospinal fluid shunt reaction the final authors note that cerebrospinal fluid shunts can improve CAH symptoms and prevent progression, but patients' responses to surgery vary from person to person Support for AQ-PCMR as CAH diagnostic and efficacy testing evidence is inconsistent Patients with cerebrospinal fluid shunt cannot be screened solely on AQ-PCMR imaging results The authors recommend continuing to look for small and accurate clinical analysis methods to determine the adaptation of chronic hydrocephalus in adults to hydrospinal shunts.