Expert panel outlines MRI protocol and criteria for iNPH

An Expert Panel Narrative Review summarizes MRI features of idiopathic normal pressure hydrocephalus (iNPH) and their role in diagnosis, identification of alternate or co-pathology, and treatment monitoring. The panel states that imaging assessment should include an unenhanced brain MRI with a 3D-T1-weighted sequence, and identifies ventriculomegaly, high-convexity narrowed sulci, and enlarged Sylvian fissures (termed DESH) along with cerebral aqueduct patency as key features supportive of an iNPH diagnosis. The review notes that utility of these MRI features for diagnosis, prognosis, and treatment monitoring has varied across studies, and provides consensus statements on MRI protocols and reporting language, including how to describe incidentally detected findings.

Most relevant for: Clinicians evaluating patients with suspected or established idiopathic normal pressure hydrocephalus presenting with gait impairment, cognitive decline, and urinary incontinence, including those being considered for CSF shunting.

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