The Role of the Glymphatic System Avaluated Thourgh mr Imaging in the Diagnosis and Management of NPH

The Role of the Glymphatic System Avaluated Thourgh mr Imaging in the Diagnosis and Management of NPH

The goal of this observational study is to evaluate the role of DTI-ALPS in the diagnostic and therapeutic management of NPH

The main questions it aims to answer are:

• Whether the glymphatic system (GS) is actually impaired in NPH
• Whether DTI-ALPS index can predict the positive response to tap test (TT) and to ventriculo-peritoneal shunt (VPS) surgery.

A healthy control group of patients (HC group) matched for age with the study group, will undergo MR with DTI-ALPS study

Enrolled patients followed a diagnostic-therapeutic pathway, consisting of the following steps:

• t0: MR with DTI-ALPS study;
• t1 (within 7 days from T0): clinical and neurosurgical assessment with NPH-specific rating scales (detailed below) before and after a lumbar TT, including measurements of opening pressure, drainage of 40-50 mL of CSF and collection of samples for neurodegenerative biomarkers (β-Amyloid 40, 42 total and P-Tau) quantification. An MR with DTI-ALPS study within 6 hours from TT;
• t2 (within 3 months from T1): patients with a positive TT response (included responders, IR group) underwent VPS surgery, with CSF samples collected for the same neurodegenerative biomarkers (β-Amyloid 40, 42 total and P-Tau);
• t3 (three months after surgery, IR group only): clinical and neurosurgical evaluation using NPH-specific rating scales to classify patients as improved, unchanged, or worsened compared to their preoperative condition; MR with DTI-ALPS study.

Suspected NPH patients according to the following:

Inclusion Criteria:

• clinical and radiological diagnosis of probable NPH according to existing guidelines
• age of over 50 years

Exclusion Criteria:

• inability to undergo MR
• diagnosis of any other neurological pathology, particularly neurodegenerative or neuroinflammatory
• previous neurosurgical interventions on the brain of any type.
• inability to undergo general anaesthesia