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Regional Cerebral Metabolic Rate of Glucose Evaluation and Clinical Assessment in Patients With Idiopathic Normal-Pressure Hydrocephalus Before and After Ventricular Shunt Placement: A Prospective Analysis

Calcagni, Maria Lucia MD*; Taralli, Silvia MD*; Mangiola, Annunziato MD; Indovina, Luca PhD; Lavalle, Mariadea MD§; De Bonis, Pasquale MD; Anile, Carmelo MD; Giordano, Alessandro MD*

Clinical Nuclear Medicine:
doi: 10.1097/RLU.0b013e31828e949b
Original Articles

Purpose: We prospectively evaluated the regional cerebral metabolic rate of glucose (CMRglu) before and after ventricular shunt placement in idiopathic normal-pressure hydrocephalus (iNPH) patients, to investigate whether some brain regions are more involved than others; we also correlated the individual variations of CMRglu with the clinical scale score assessment after shunting.

Methods: Twenty iNPH patients (12 men; mean age 73 ± 9 years) underwent clinical scale score assessment and 18F-FDG PET-CT before and 1 week after shunting.

Results: Before shunting, CMRglu values were similar in right and left brain regions, as well as after shunting. After shunting, 17 of 20 iNPH patients were clinically improved; all scale scores decreased, and CMRglu significantly increased in all regions (P < 10−7). In 3 of 20 iNPH patients, the symptoms persisted, the scale scores did not change, and CMRglu increased only in 3 regions: left frontal, left putamen, and right thalamus. Before shunting, no difference in global CMRglu between clinically improved (n = 17) and not improved (n = 3) iNPH patients was found. After shunting, a significant (P = 0.01) correlation between individual variations of CMRglu and clinical assessment was found.

Conclusions: These findings confirm that iNPH is a disease involving all cerebral regions almost in the same way, and shunt procedure has a similar effect on regional cerebral metabolism almost in the same way. Individual variations of CMRglu are more important than absolute values and correlate with clinical status after shunting. Clinical improvement depends not only on the capability to restore the cerebrospinal fluid dynamic, but also on the ability of cerebral parenchyma to recover the metabolic function.

Author Information

From the Institutes of *Nuclear Medicine, †Neurosurgery, ‡Physics, Università Cattolica del Sacro Cuore, Rome; and §Division of Nuclear Medicine, Humanitas Gavazzeni, Bergamo, Italy.

Received for publication November 5, 2012; revision accepted February 12, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Maria Lucia Calcagni, MD, Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy. E-mail:

© 2013 by Lippincott Williams & Wilkins