Reevaluation of Radionuclide Cisternography in the Elderly, with Special Reference to Frequent Occurrences of Pseudo NPH

• Published in: Nihon Rōnen Igakkai zasshi Vol. 24; no. 4; pp. 361 - 368
• Main Authors: Kurihara, Norimitsu, Nishino, Hideo, Tanno, Munehiko, Yamada, Hideo, Ide, Hiroshi, Chiba, Kazuo
• Format: Journal Article
• Language: Japanese
• Published: Japan The Japan Geriatrics Society 01.07.1987
• Subjects: Aged; Aged, 80 and over; Cerebral Ventricles - diagnostic imaging; cerebrospinal fluid dynamics; Cisterna Magna - diagnostic imaging; computed tomography; Evaluation Studies as Topic; Humans; Hydrocephalus - epidemiology; Hydrocephalus, Normal Pressure - diagnosis; Hydrocephalus, Normal Pressure - epidemiology; Intracranial Pressure; normal pressure hydrocephalus; Radiography; radionuclide cisternography; Radionuclide Imaging
• ISSN: 0300-9173
• DOI: 10.3143/geriatrics.24.361

In order to evaluate a clinical significance of radionuclide cisternography (RC) in geriatrics, RC using 111In-DTPA was performed in 201 patients. In most of them the study was undertaken to rule out normal pressure hydrocephalus (NPH). Cisternographic images were classified into six major groups on the basis of degree of ventricular filling: (1) no ventricular reflux (VR) (Type I); (2) transient VR (Type II); (3) delayed VR (Type III); (4) gradually increasing VR (Type IV); (5) low concentration persistent VR (Type V); (6) high concentration persistent VR (Type VI). These cisternographic findings were compared with CT findings, cerebrospinal fluid pressure and clinical symptoms. Some degree of ventricular reflux could be observed in about 50% of the 201 patients. However, Type VI which was most compatible with classical NPH was observed only in 6% of all cases and Type V was in 9%. Incidence of each type of positive ventricular reflux did not show any difference between patients with CVD and those without CVD. In patients with history of SAH, on the other hand, Type VI pattern cisternography was observed in forty percent of the subjects. In patients showing type VI cisternography the lateral ventricle was significantly enlarged on CT images and cerebrospinal fluid pressure was significantly elevated compared with patients of Type I. Anterior horn of the lateral vetricle was also dilated in those patients. Clinical implication of ventricular reflux on radionuclide cisternography in elderly patients was discussed in conjunction with relatively small incidence of true NPH.