ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2025
Implications of the glymphatic system in the diagnostic and surgical workup of normal pressure hydrocephalus.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Diffusion tensor image analysis along the perivascular space (DTI-ALPS): redefining its interpretation and role.Japanese journal of radiology · 2026Review
- Cerebrospinal fluid and plasma biomarkers in idiopathic normal pressure hydrocephalus: comparison with Alzheimer's and Parkinson's diseases.Frontiers in aging neuroscience · 2026Article
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13 authors.
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Abstract
backgroundMagnetic Resonance (MRI) Diffusion Tensor Imaging Analysis ALong the Perivascular Space (DTI-ALPS) is a promising technique that assesses the glymphatic system (GS) function in many neurodegenerative diseases. This study aims at evaluating the role of DTI-ALPS in the diagnostic and therapeutic management of normal pressure hydrocephalus (NPH).
methodsTwenty-one NPH patients underwent 3 Tesla MRI DTI-ALPS before and after lumbar tap test (TT). Depending on the response to TT, patients were divided into a responsive cohort (15 responders, R) and non-responsive cohort (6 non-responders, NR). R patients underwent ventriculoperitoneal shunt (VPS) surgery, with clinical assessment upon discharge and at a 3-month follow-up (FU) visit; nine patients repeated DTI-ALPS MRI at FU. Besides, 8 matched healthy controls (HC) underwent the same MRI protocol.
resultsThe pre-TT ALPS-index in NPH patients (R: 1.003 ± 0.108, NR: 0.960 ± 0.079) was significantly lower compared to the HC (1.263 ± 0.161, p < 0.01). The pre-TT ALPS-index in R patients was higher than in NR patients, though not significantly (p = 0.39). Compared to the pre-TT values, the ALPS-index of the R group increased both post TT (1.069 ± 0.122, p = 0.0499) and post VPS (1.120 ± 0.117, p = 0.041), in accordance to the clinical outcome.
conclusionsDTI-ALPS, reflecting the GS function, resulted significantly lower in NPH patients than in healthy controls. Secondly, clinical improvement was associated with DTI-ALPS increase both after a positive response to TT and at long term follow-up following VPS surgery. Therefore, DTI-ALPS index could be a promising, rapid and non-invasive radiological biomarker for the pre-surgical evaluation and prognosis of NPH patients.
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