Citation, DOI, disclosures and article data
Citation:
Knipe H, iNPH Radscale. Reference article, Radiopaedia.org (Accessed on 16 Mar 2025) https://doi.org/10.53347/rID-161370
Disclosures:
At the time the article was created Henry Knipe had the following disclosures:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
These were assessed during peer review and were determined to
not be relevant to the changes that were made.
View Henry Knipe's current disclosures
Disclosures:
At the time the article was last revised Henry Knipe had the following disclosures:
- Micro-X Ltd, Shareholder (past)
These were assessed during peer review and were determined to
not be relevant to the changes that were made.
View Henry Knipe's current disclosures
The iNPH Radscale is a grading scale for normal pressure hydrocephalus (NPH) imaging findings. However, this score is not useful in selecting patients who will respond to shunt surgery, which may limit its clinical utility 6,7.
Classification
The iNPH Radscale uses the following imaging findings on both CT and MRI 1,4:
-
Evans index
≤0.25: 0 points
0.26-0.3: 1 point
>0.3: 2 points
-
narrow parietal high-convexity and medial parafalcine sulci: assessed in the most superior axial and coronal planes
normal: 0 points
parafalcine: 1 point
vertex: 2 points
-
Sylvian fissures: compared to adjacent sulci in the coronal plane
normal: 0 points
enlarged: 1 point
-
focally enlarged sulci compared to surrounding sulci
not present: 0 points
present: 1 point
-
temporal horns: measured in the axial plane
<4 mm: 0 points
4-5.9 mm: 1 point
≥6 mm: 2 points
-
callosal angle
>90°: 0 points
90-59.9°: 1 point
≤60°: 2 points
-
periventricular white matter change
not present (Fazekas grade 0): 0 points
frontal horn caps (Fazekas grade 1): 1 point
confluent areas (Fazekas grade 2-3): 2 points
Interpretation
iNPH Radscale scores of >8 have been shown to have high sensitivity (>90%) for NPH in patients with clinical symptoms 2,3 although iNPH Radscale scores alone have not predicted the response to shunt surgery 5-7.
-
1. Kockum K, Lilja‐Lund O, Larsson E et al. The Idiopathic Normal‐pressure Hydrocephalus Radscale: A Radiological Scale for Structured Evaluation. Eur J Neurol. 2018;25(3):569-76. doi:10.1111/ene.13555 - Pubmed
-
2. Kockum K, Virhammar J, Riklund K, Söderström L, Larsson E, Laurell K. Diagnostic Accuracy of the INPH Radscale in Idiopathic Normal Pressure Hydrocephalus. PLoS One. 2020;15(4):e0232275. doi:10.1371/journal.pone.0232275 - Pubmed
-
3. Fällmar D, Andersson O, Kilander L, Löwenmark M, Nyholm D, Virhammar J. Imaging Features Associated with Idiopathic Normal Pressure Hydrocephalus Have High Specificity Even when Comparing with Vascular Dementia and Atypical Parkinsonism. Fluids Barriers CNS. 2021;18(1):35. doi:10.1186/s12987-021-00270-3 - Pubmed
-
4. Kockum K, Virhammar J, Riklund K, Söderström L, Larsson E, Laurell K. Standardized Image Evaluation in Patients with Idiopathic Normal Pressure Hydrocephalus: Consistency and Reproducibility. Neuroradiology. 2019;61(12):1397-406. doi:10.1007/s00234-019-02273-2 - Pubmed
-
5. Chen J, He W, Zhang X et al. Value of MRI-Based Semi-Quantitative Structural Neuroimaging in Predicting the Prognosis of Patients with Idiopathic Normal Pressure Hydrocephalus After Shunt Surgery. Eur Radiol. 2022;32(11):7800-10. doi:10.1007/s00330-022-08733-3 - Pubmed
-
6. Ghosh D, Gilson P, Kundrick A et al. Using the INPH Radscale as a Radiological Predictor of Clinical Outcomes After Ventriculoperitoneal Shunt Placement in Patients with Idiopathic Normal Pressure Hydrocephalus (INPH) (P9-11.014). Neurology. 2023;100(17_supplement_2). doi:10.1212/wnl.0000000000203754
-
7. Carlsen J, Backlund A, Mardal C et al. Can Shunt Response in Patients with Idiopathic Normal Pressure Hydrocephalus Be Predicted from Preoperative Brain Imaging? A Retrospective Study of the Diagnostic Use of the Normal Pressure Hydrocephalus Radscale in 119 Patients. AJNR Am J Neuroradiol. 2022;43(2):223-9. doi:10.3174/ajnr.A7378 - Pubmed
Promoted articles (advertising)
Unable to process the form. Check for errors and try again.